Provider Demographics
NPI:1528674090
Name:SULLIVAN, ELIZABETH ROCKETT (BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROCKETT
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HIGHLAND DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2438
Mailing Address - Country:US
Mailing Address - Phone:619-961-2015
Mailing Address - Fax:
Practice Address - Street 1:990 HIGHLAND DR STE 310
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2438
Practice Address - Country:US
Practice Address - Phone:619-961-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA1-20-44411103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst