Active NPI
Pauline M. Sullivan, MED
- Professional Counselor
- Escondido, CA
National Provider Identifier
1396973830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-18621
- Practice address
- 1815 N Broadway Apt 66
Escondido, CA 92026-2066 - Phone
- (442) 300-4934
- NPI assigned
- Jun 23, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LMHC-4366 | MA | |
| Professional Counselor | 101YP2500X | LPC-18621 | AZ | Primary |
Addresses
Primary practice location
1815 N Broadway Apt 66
Escondido, CA 92026-2066
Mailing address
PO Box 552
Escondido, CA 92033-0552
Phone (442) 300-4934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-18621 | AZ | MD | Professional Counselor |
| LMHC-4366 | MA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688342400000",
"number": "1396973830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 552",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920330552",
"telephone_number": "442-300-4934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1815 N BROADWAY APT 66",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920262066",
"telephone_number": "442-300-4934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "PAULINE",
"middle_name": "M.",
"credential": "MED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-23",
"last_updated": "2023-07-03",
"certification_date": "2023-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MA",
"license": "LMHC-4366",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-18621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escondido, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.