Individual
MR. MARTIN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
41 RECKLESS PL, RED BANK, NJ 07701-1703
(732) 996-9072
(732) 530-4534
Mailing address
32 BUENA VISTA AVE, FAIR HAVEN, NJ 07704-3526
(732) 996-9072
(732) 530-4534
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00315100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0043532
—
NJ
Enumeration date
05/07/2007
Last updated
07/09/2007
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