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General NPI Number Information
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NPI Number | 1891278669
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Entity Type | Individual
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Provider Name | PAUL JOSEPH SULLIVAN PHD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 81 HARTWELL AVE STE 310
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City | LEXINGTON
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State | MA
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Zip | 02421-3177
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Country | US
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Telephone | 781-918-6860
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Fax |
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Provider Business Mailing Address
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Address Line | 81 HARTWELL AVE STE 310
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City | LEXINGTON
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State | MA
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Zip | 02421-3177
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Country | US
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Telephone | 508-873-2396
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 10000604
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 022843
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002253
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License Number State | RI
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