Basic Information
| Provider Information | |||||||||
| NPI: | 1457553216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | SUMMER | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20191 E COUNTRY CLUB DR APT 1602 | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331803019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055052742 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19022 NE 29TH AVE | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331802823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059361002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 05/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | PY 7923 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.