Individual
DIANE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
72 ACHILLES WAY, NORTH ATTLEBORO, MA 02763-4018
(508) 838-7192
Mailing address
72 ACHILLES WAY, NORTH ATTLEBORO, MA 02763-4018
(508) 838-7192
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
114572
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114572
LICSW
MA
Enumeration date
03/20/2018
Last updated
03/20/2018
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