Individual
STEPHANIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LAC, NCC
Contact information
Practice address
145 MAPLE AVE, RED BANK, NJ 07701-1717
(732) 747-9660
Mailing address
145 MAPLE AVE, RED BANK, NJ 07701-1717
(732) 747-9660
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
37AC00159000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210634494
—
NJ
Enumeration date
12/22/2014
Last updated
12/22/2014
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