MEDICARE: COLLEEN SULLIVAN 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	101YM0800X	Mental Health Counselor	37PC01226300	NJ

General Provider Information

NPI Number	:	1972358026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN SULLIVAN LPC

Provider Business Mailing Address
First Line	:	74 BRICK BLVD STE 204
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-7984
Country	:	US
Telephone Number	:	732-832-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	74 BRICK BLVD STE 204
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-7984
Country	:	US
Telephone Number	:	732-832-3444
Fax Number	:

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

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/02/2026

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Directions to “ COLLEEN SULLIVAN LPC” Practice Location

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