Individual
PAUL J SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11-12 BROADWAY AVE, GLOVERSVILLE, NY 12078
(518) 725-4310
(518) 725-2556
Mailing address
2H FULHAM RD, CLIFTON PARK, NY 12065-6322
(518) 244-0155
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
28067
NY
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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