Individual
AMY JEAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
139 CORNELL ST, KINGSTON, NY 12401-3633
(845) 338-1234
(845) 338-6284
Mailing address
17 BOSCO DR, JACKSONVILLE, NC 28540-3727
(845) 532-1936
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
104100000X
Social Worker
082906-1
NY
1041C0700X
Clinical Social Worker
C009781
NC
Other
Enumeration date
06/21/2011
Last updated
09/23/2020
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