Carolyn Nicole Sullivan

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

001501 Issued in NY

Practice address

341 Trinity St
Malverne, NY 11565-1234

Phone

(631) 624-3256

NPI assigned

Jul 11, 2019

Last updated

Jan 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1730731506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 S 13TH ST",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117574552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 TRINITY ST",
            "city": "MALVERNE",
            "state": "NY",
            "postal_code": "115651234",
            "telephone_number": "631-624-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "CAROLYN",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-11",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NY",
            "license": "001501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "abc123",
            "affiliation": "N",
            "address_1": "600 Bayview Ave Ste 100",
            "city": "Inwood",
            "state": "NY",
            "country_code": "US",
            "postal_code": "110961625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "abc123",
            "affiliation": "N",
            "address_1": "341 Trinity St",
            "city": "Malverne",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115651234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jillian Sopp
• Soul Discovery Mental Health Counseling Services PC
• South Shore Midwives, PLLC
• Speech4Parents
• Alexandra G St. Louis, M.D.
• Daniel Benjamin Szulkin, M.S. ED, SDA
• The Body Place Mental Health Counseling P.C.
• The Kid Spot for Speech, Physical, and Occupational Therapy, PLLC
• The Medex Medical PC
• The Well of Truth, Inc. (The Well, Inc.)

• Behavior Analyst in Malverne, NY
• Providers in Malverne, NY by specialty
• Behavior Analyst in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.

Verify at the official NPI Registry.