Individual
CAROLYN NICOLE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
341 TRINITY ST, MALVERNE, NY 11565-1234
(631) 624-3256
Mailing address
425 S 13TH ST, LINDENHURST, NY 11757-4552
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
001501
NY
Other
Enumeration date
07/11/2019
Last updated
01/05/2023
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