Provider Demographics
NPI:1679881668
Name:O'SULLIVAN, ROBYN HACKFORD (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:HACKFORD
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2103
Mailing Address - Country:US
Mailing Address - Phone:718-476-0611
Mailing Address - Fax:
Practice Address - Street 1:3907 45TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2103
Practice Address - Country:US
Practice Address - Phone:718-476-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018679103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist