Provider Demographics
NPI:1568016293
Name:O'SULLIVAN, SUSAN LAUREN (BCBA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LAUREN
Last Name:O'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 1:470A LIBERTY ST.
Mailing Address - Street 2:APT. 303
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643
Mailing Address - Country:US
Mailing Address - Phone:201-694-1139
Mailing Address - Fax:
Practice Address - Street 1:470A LIBERTY ST.
Practice Address - Street 2:APT. 303
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643
Practice Address - Country:US
Practice Address - Phone:201-694-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst