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General NPI Number Information
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NPI Number | 1700762754
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Entity Type | Individual
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Provider Name | KATHERINE KELLY SULLIVAN
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Gender |
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 222 MOUNT AIRY RD
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-2335
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Country | US
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Telephone | 908-350-9143
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Fax |
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Provider Business Mailing Address
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Address Line | 17 HAWTHORNE RD
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City | ESSEX FELLS
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State | NJ
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Zip | 07021-1411
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Country | US
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Telephone | 973-865-4648
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00900800
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License Number State | NJ
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