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Individual
PATRICIA SULLIVAN JANE SULLIVAN
Active
Individual
PATRICIA SULLIVAN JANE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
975
MA
1041C0700X
Clinical Social Worker
Primary
1025888
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1859218
—
MA
Enumeration date
11/20/2006
Last updated
06/07/2013
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