Individual
DR. THOMAS E. SULLIVAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2810 MACK RD, FAIRFIELD, OH 45014-5130
(513) 874-4530
(513) 346-3811
Mailing address
2810 MACK RD, FAIRFIELD, OH 45014-5130
(513) 874-4530
(513) 346-3811
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
5083
OH
103T00000X
Psychologist
Primary
5083
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000066833
ANTHEM ID#
OH
01
—
257968
VALUE OPTIONS PROVIDER ID
OH
01
—
A294802
VALUE OPTIONS VIN
OH
Enumeration date
02/22/2006
Last updated
09/11/2025
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