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DR. THOMAS E. SULLIVAN PH.D.

Clinical Neuropsychologist

Fairfield, Ohio

Provider NPI: 1316912421

Provider Information:
DR. THOMAS E. SULLIVAN PH.D.
Gender: M


Practice Location:
2810 MACK RD  FAIRFIELD, OH 45014 US
Tel: 513-874-4530  Fax: 513-346-3811

Business Mailing Address:
2810 MACK RD  FAIRFIELD, OH 45014 US
Tel: 513-874-4530  Fax: 513-346-3811

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
OH5083
X103T00000XBehavioral Health & Social Service Providers
Psychologist
OH5083

Other Provider Identifiers:

IssuerNumberStateType
ANTHEM ID#000000066833OH01
VALUE OPTIONS PROVIDER ID257968OH01
VALUE OPTIONS VINA294802OH01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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