Provider Demographics
NPI:1184957888
Name:SULLIVAN, DEBORAH M (BCBA)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:MONIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343
Mailing Address - Country:US
Mailing Address - Phone:774-849-2022
Mailing Address - Fax:
Practice Address - Street 1:SEVITA
Practice Address - Street 2:103 COMMERCIAL ST
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302
Practice Address - Country:US
Practice Address - Phone:508-521-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4897103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst