Provider Demographics
NPI:1588764674
Name:SULLIVAN, KATHLEEN D (LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 W PRATT ST
Mailing Address - Street 2:3RD. FLR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-2539
Mailing Address - Fax:410-328-8476
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:3RD. FLR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-2539
Practice Address - Fax:410-328-8476
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDLC12812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry