Provider Demographics
NPI:1427481027
Name:O'SULLIVAN, CATHERINE MARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARY
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-0004
Mailing Address - Country:US
Mailing Address - Phone:845-416-7839
Mailing Address - Fax:
Practice Address - Street 1:75 N MAPLE AVE
Practice Address - Street 2:SUITE 101B
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3247
Practice Address - Country:US
Practice Address - Phone:845-416-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00550000103G00000X, 103T00000X, 103TB0200X
NY021138103G00000X, 103TB0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral