Active NPI
Charles D Sullivan, PHD
- Clinical Psychologist
- Totowa, NJ
National Provider Identifier
1144433863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 355100121900
- Practice address
- 265 Route 46 West
Suite 202
Totowa, NJ 07512 - Phone
- (973) 256-2818
- Fax
- (973) 256-2818
- NPI assigned
- May 8, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 355100121900 | NJ | Primary |
Addresses
Primary practice location
265 Route 46 West
Suite 202
Totowa, NJ 07512
Mailing address
265 Route 46 West
Suite 202
Totowa, NJ 07512
Phone (973) 256-2818
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1282905 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050523000845 | NJ | Practitioner - Clinical Psychologist | 0547202384 | Practice locations: Totowa, NJ |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- University of North Dakota School of Medicine, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
265 Route 46 W
Suite 202
Totowa, NJ 07512-1820
Phone (973) 256-2818
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 355100121900 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144433863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265 ROUTE 46 WEST",
"address_2": "SUITE 202",
"city": "TOTOWA",
"state": "NJ",
"postal_code": "07512",
"telephone_number": "973-256-2818",
"fax_number": "973-256-2818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265 ROUTE 46 WEST",
"address_2": "SUITE 202",
"city": "TOTOWA",
"state": "NJ",
"postal_code": "07512",
"telephone_number": "973-256-2818",
"fax_number": "973-256-2818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CHARLES",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "355100121900",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1282905",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Totowa, NJ
- St Joseph's Health Pharmacy, LLC
- State of New Jersey Omb Centralized Payroll (North Jersey Developmental Center)
- Norman Robert Stegen Jr., RPH
- Christine Michelle Sticco, M.D.
- Nicole V Struble, MSOT, OTR/L
- Ryan Charles Sullivan, PSY.D.
- Summit Chiropractic LLC
- Naim Fahkree Sylvester, DMD
- T & F Drugs Inc (Burgio's Pharmacy)
- Marcia Takach
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.