Provider Demographics
NPI:1396176772
Name:SULLIVAN, DANIEL (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:500 8TH AVE
Mailing Address - Street 2:SUITE300
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6504
Mailing Address - Country:US
Mailing Address - Phone:212-904-1500
Mailing Address - Fax:212-904-1515
Practice Address - Street 1:620 ROUTE 303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1170
Practice Address - Country:US
Practice Address - Phone:845-353-2730
Practice Address - Fax:845-353-1513
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087613104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker