Provider Demographics
NPI:1730343666
Name:SULLIVAN, JAMES EDWARD (MA PSY)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ADMIRAL KALBFUS RD APT 12E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1372
Mailing Address - Country:US
Mailing Address - Phone:718-909-6197
Mailing Address - Fax:
Practice Address - Street 1:2076 WALLUM LAKE RD
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859
Practice Address - Country:US
Practice Address - Phone:401-568-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)