Lakeasha Garner Sullivan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS-T001046 Issued in GA

Practice address

304 W 115TH St
2A
New York, NY 10026-2350

Phone

(212) 222-1754

NPI assigned

Jan 22, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Lakeasha Garner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1720265796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 W 115TH ST",
            "address_2": "2A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100262350",
            "telephone_number": "212-222-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 W 115TH ST",
            "address_2": "2A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100262350",
            "telephone_number": "212-222-1754"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 McFarland Ave",
            "address_purpose": "LOCATION",
            "city": "Rossville",
            "state": "GA",
            "postal_code": "307412215",
            "country_code": "US",
            "telephone_number": "800-275-3243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LAKEASHA",
        "middle_name": "GARNER",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-22",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "017515",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PS-T001046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAKEASHA",
            "last_name": "GARNER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine Anne Sullivan, PH.D.
• Kathryn Sullivan, PHD
• Kayla Sullivan
• Kendall Julia Sullivan, LMSW
• Kevin M Sullivan, M.D.
• Lawrence Sullivan, NCPSYA
• Lawrence Christopher Sullivan, M.D.
• Leslie Sullivan, LMHC
• Logan Tyler Sullivan
• Madonna Sullivan, LMSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.