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General NPI Number Information
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NPI Number | 1396973830
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Entity Type | Individual
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Provider Name | PAULINE M. SULLIVAN MED
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Gender | Female
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 1815 N BROADWAY APT 66
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City | ESCONDIDO
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State | CA
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Zip | 92026-2066
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Country | US
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Telephone | 442-300-4934
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 552
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City | ESCONDIDO
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State | CA
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Zip | 92033-0552
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Country | US
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Telephone | 442-300-4934
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LMHC-4366
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-18621
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License Number State | AZ
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