Sullivan, Mandy

Sullivan, Mandy is an individual health care provider with primary practice located at 635 Main St , Middletown CT 06457-2718. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Sullivan, Mandy can be contacted via phone (860) 347-6971.

Contact Information

Primary practice address
635 Main St Middletown CT 06457-2718
Fax: (860) 704-8034
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 002169 Connecticut

Profile Details

NPI number 1982960431
LBN Legal business name Sullivan, Mandy
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2012
Last updated Apr 10th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982960431 NPPES
Connecticut MEDICAID 004236338

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