Melba J Sullivan, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

018720 Issued in NY

Practice address

330 W 58TH St Ste 208
New York, NY 10019-1822

Phone

(347) 725-0339

NPI assigned

Mar 28, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Melba Jenine Nicholson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ackerman Institute for the Family

  • Marriage & Family Therapist
  • New York, NY
  • NPI 1467505792
  NPD (past)
• Ackerman Institute for the Family

  • Case Management Agency
  • New York, NY
  • NPI 1740680511
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552435200000",
    "number": "1427177484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 BROADWAY FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100108104",
            "telephone_number": "212-879-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W 58TH ST STE 208",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191822",
            "telephone_number": "347-725-0339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "462 First Avenue, CD 738",
            "address_2": "Program for Survivors of Torture/Bellevue Hospital",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10016",
            "country_code": "US",
            "telephone_number": "212-683-7446",
            "fax_number": "212-994-7177",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "936 Broadway Fl 2",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100108104",
            "country_code": "US",
            "telephone_number": "323-793-5831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MELBA",
        "middle_name": "J",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2019-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 22925",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071006957",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "018720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELBA",
            "last_name": "NICHOLSON",
            "middle_name": "JENINE",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marisa Sullivan, MSN, AGACNP-BC
• Mark Sullivan, M.D.
• Martha Adams Sullivan, DSW
• Matthew Conor Sullivan, PH.D.
• Meg Shannon Sullivan, MD
• Michelle Suzanne Sullivan, PA-C
• Peter Sullivan
• Richard C Sullivan, PHD
• Robert Sullivan, P.A.-C
• Robert G Sullivan

• Psychologist in New York, NY
• Providers in New York, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.