Individual
DIANE BRASHER SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
11116 MEDICAL CAMPUS RD, SUITE 2989, HAGERSTOWN, MD 21742-6710
(301) 766-7600
(301) 766-4976
Mailing address
11116 MEDICAL CAMPUS RD, SUITE 2989, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
07726
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000395600
—
MD
01
—
091951
VALUE OPTIONS
MD
01
—
509904
PHCS
MD
01
—
7163302
AETNA
MD
Enumeration date
10/06/2006
Last updated
03/14/2011
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