Healthcare Provider Details

I. General information

NPI: 1235729716
Provider Name (Legal Business Name): LAUREN SULLIVAN LPC, MED, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 BOXWOOD RD
BRYN MAWR PA
19010-1222
US

IV. Provider business mailing address

424 BOXWOOD RD
BRYN MAWR PA
19010-1222
US

V. Phone/Fax

Practice location:
  • Phone: 610-955-7892
  • Fax:
Mailing address:
  • Phone: 610-955-7892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC016591
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC016591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: