Individual
MARY A SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCNS
Contact information
Practice address
50 MAUDE ST, PROVIDENCE, RI 02908-4325
(401) 456-2000
(401) 456-6554
Mailing address
50 MAUDE ST, PROVIDENCE, RI 02908-4325
(401) 456-2000
(401) 456-6554
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PPNS00073
RI
363LG0600X
Gerontology Nurse Practitioner
Primary
21544
CA
Other
Enumeration date
07/17/2006
Last updated
02/02/2012
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