Provider Demographics
NPI:1528352929
Name:SULLIVAN, RYAN CHARLES (PSYD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHARLES
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 US HIGHWAY 46
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1820
Mailing Address - Country:US
Mailing Address - Phone:973-256-2818
Mailing Address - Fax:
Practice Address - Street 1:265 US HIGHWAY 46
Practice Address - Street 2:SUITE 202
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1820
Practice Address - Country:US
Practice Address - Phone:973-256-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100485600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical