Individual
KELLY J SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-A
Contact information
Practice address
249 GLENWOOD RD, BINGHAMTON, NY 13905-1603
(607) 427-2109
Mailing address
249 GLENWOOD RD, BINGHAMTON, NY 13905-1603
(607) 427-2109
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
38339
NY
Other
Enumeration date
07/30/2025
Last updated
07/30/2025
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