Healthcare Provider Details

I. General information

NPI: 1710710421
Provider Name (Legal Business Name): MARY SULLIVAN-RITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 PASSMORE RD
WILMINGTON DE
19803-1548
US

IV. Provider business mailing address

701 SOUTH ST APT 2
HISTORIC NEW CASTLE DE
19720-5079
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-9411
  • Fax:
Mailing address:
  • Phone: 302-723-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012545
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: