Individual
MELBA J SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
330 W 58TH ST STE 208, NEW YORK, NY 10019-1822
(347) 725-0339
Mailing address
936 BROADWAY FL 2, NEW YORK, NY 10010-8104
(212) 879-4900
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
018720
NY
103T00000X
Psychologist
PSY 22925
CA
103TC2200X
Clinical Child & Adolescent Psychologist
071006957
IL
Other
Enumeration date
03/28/2007
Last updated
03/13/2019
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