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1609658962 NPI number — RAYMOND DAVID SULLIVAN PSYD

NPI Number: 1609658962
Health Care Provider/Practitioner: RAYMOND DAVID SULLIVAN PSYD

Information about “1609658962” NPI (RAYMOND DAVID SULLIVAN PSYD) exists in 1609658962 in HTML format HTML  |  1609658962 in plain Text format TXT  |  1609658962 in PDF (Portable Document Format) PDF  |  1609658962 in an XML format XML  formats.

NPI Number : 1609658962 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609658962",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SULLIVAN",
    "FirstName": "RAYMOND",
    "MiddleName": "DAVID",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SULLIVAN",
    "OtherFirstName": "RAY",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PSYD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "PO BOX 5591",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANTA BARBARA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93150-5591",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-689-2233",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5276 HOLLISTER AVE STE 205",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA BARBARA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93111-3066",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "805-392-8057",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/19/2023",
    "LastUpdateDate": "10/27/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "PSB94027027018",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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