MEDICARE: DANIEL SULLIVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	020298	NY

General Provider Information

NPI Number	:	1225355969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL SULLIVAN

Provider Business Mailing Address
First Line	:	800 POLY PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-7104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	372 FULLERTON AVE STE 6
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-3744
Country	:	US
Telephone Number	:	508-414-3215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/29/2026

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