Provider Demographics
NPI:1538835202
Name:RUBINSON SULLIVAN, IRENE (LAMFT)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:RUBINSON SULLIVAN
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1416
Mailing Address - Country:US
Mailing Address - Phone:201-694-0684
Mailing Address - Fax:
Practice Address - Street 1:440 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4378
Practice Address - Country:US
Practice Address - Phone:973-746-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00020500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist