Healthcare Provider Details

I. General information

NPI: 1770705410
Provider Name (Legal Business Name): ANN MACGREGOR SULLIVAN M.S. , BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 STEELE RD
NEW HARTFORD CT
06057-2612
US

IV. Provider business mailing address

20 STEELE RD
NEW HARTFORD CT
06057-2612
US

V. Phone/Fax

Practice location:
  • Phone: 860-738-9442
  • Fax: 860-738-9442
Mailing address:
  • Phone: 860-738-9442
  • Fax: 860-738-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: