Provider Demographics
NPI:1124773049
Name:SULLIVAN, MADISON DELAINEY (BCBA, LBS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:DELAINEY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 FORBES AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3010
Mailing Address - Country:US
Mailing Address - Phone:412-684-2890
Mailing Address - Fax:
Practice Address - Street 1:3109 FORBES AVE STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3010
Practice Address - Country:US
Practice Address - Phone:412-684-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-22-57871103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst