Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1093233645 |
---|---|
Provider Name | Dr. Ashley Cameron Sultan |
First Address | Brookline, MA 02445-7237 |
Second Address | Boston, MA 02135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2017 |
Last Update Date | 23/09/2021 |