Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | F400291 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F400291 | NY |
NPI | 1003929373 |
---|---|
Provider Name | Ms. Marilyn Sullivan |
First Address | Webster, NY 14580-2103 |
Second Address | Webster, NY 14580-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 24/05/2021 |