MEDICARE: MARGARET SUNNY SULLIVAN-FULLERTON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00671000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37PC00671000	OTHER	NJ	NEW JERSEY STATE COUNSELING BOARD

General Provider Information

NPI Number	:	1205434214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET SUNNY SULLIVAN-FULLERTON LPC

Provider Business Mailing Address
First Line	:	63 ROCKWOOD DR
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-4152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 ROCKWOOD DR
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-4152
Country	:	US
Telephone Number	:	201-317-3406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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