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NPI Code Detail

MEDICARE: MRS. ANTOINETTE O SULLIVAN LICSW

MEDICARE: MRS. ANTOINETTE O SULLIVAN LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerISW01516RI

General Provider Information

NPI Number : 1366582819
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANTOINETTE O SULLIVAN LICSW
Provider Business Mailing Address
First Line : 10 DAVOL SQ
Second Line : SUITE 400
City : PROVIDENCE
State : RI
Zip : 02903-4754
Country : US
Telephone Number : 401-421-4000
Fax Number : 401-272-1456
Provider Business Practice Location Address
First Line : 65 VILLAGE SQUARE DR
Second Line :
City : SOUTH KINGSTOWN
State : RI
Zip : 02879-2292
Country : US
Telephone Number : 401-789-5924
Fax Number : 401-782-1770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 04/09/2024

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Directions to “ MRS. ANTOINETTE O SULLIVAN LICSW” Practice Location

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