Individual
MR. CHARLES SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
10 HIGH ST STE 10, MEDFORD, MA 02155-3848
(781) 395-1560
(781) 391-5564
Mailing address
PO BOX 681, NEWPORT, VT 05855-0681
(781) 254-4958
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.0060196
VT
Other
Enumeration date
11/28/2006
Last updated
01/04/2010
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