Individual
DR. MAURA D. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3583 NE BROADWAY ST, PORTLAND, OR 97232-1820
(503) 432-8470
(503) 912-7018
Mailing address
3583 NE BROADWAY ST, PORTLAND, OR 97232-1820
(503) 432-8470
(503) 912-7018
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1012
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30425095
—
NH
Enumeration date
06/08/2006
Last updated
01/23/2024
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