Individual
MICHAELLE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
622-624 VALLEY RD, UPPER MONTCLAIR, NJ 07043-1462
(732) 674-9857
Mailing address
73 ELM ST APT 1, MONTCLAIR, NJ 07042-3265
(862) 285-1869
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00855800
NJ
Other
Enumeration date
02/17/2025
Last updated
02/17/2025
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