Individual
SIOBHAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
31 THURBER DR, WATERLOO, NY 13165-1649
(315) 539-1985
Mailing address
31 THURBER DR, WATERLOO, NY 13165-1649
(315) 539-1985
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5873
NY
Other
Enumeration date
07/24/2014
Last updated
07/24/2014
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