Provider Demographics
NPI:1336981877
Name:SULLIVAN, BRENNA KATHRYN
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:KATHRYN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NOEL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-5309
Mailing Address - Country:US
Mailing Address - Phone:201-283-4702
Mailing Address - Fax:
Practice Address - Street 1:19 NOEL DR
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-5309
Practice Address - Country:US
Practice Address - Phone:201-283-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician