Individual
CASSANDRA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
39 INDIANA AVE, LONG BEACH, NY 11561-1207
(845) 978-5033
Mailing address
39 INDIANA AVE, LONG BEACH, NY 11561-1207
(845) 978-5033
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1275656
NY
Other
Enumeration date
03/31/2023
Last updated
08/16/2023
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