Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6297 | OH |
Y | 103TC0700X | Clinical Psychologist | 6297 | OH |
NPI | 1013124742 |
---|---|
Provider Name | Dr. Amy Burleson Sullivan |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 28/06/2011 |