Provider Demographics
NPI:1861159857
Name:SUN PSYCHOLOGICAL
Entity type:Organization
Organization Name:SUN PSYCHOLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-774-1335
Mailing Address - Street 1:614 WALNUT HILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2713
Mailing Address - Country:US
Mailing Address - Phone:917-774-1335
Mailing Address - Fax:
Practice Address - Street 1:1901 NW MILITARY HWY STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2132
Practice Address - Country:US
Practice Address - Phone:201-864-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty