Provider Demographics
NPI:1962128413
Name:O'SULLIVAN, GERALDINE (LCSW, PPSC)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BEAR VALLEY PKWY S
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7699
Mailing Address - Country:US
Mailing Address - Phone:760-291-6053
Mailing Address - Fax:
Practice Address - Street 1:3300 BEAR VALLEY PKWY S
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-7699
Practice Address - Country:US
Practice Address - Phone:760-291-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA792931041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool