Individual
JENNIFER MARIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
450 WASHINGTON ST STE 201, DEDHAM, MA 02026-4449
(781) 449-1884
Mailing address
2401 VANDERBILT LN UNIT C, REDONDO BEACH, CA 90278-3213
(310) 592-1900
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
6534
MA
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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