Healthcare Provider Details

I. General information

NPI: 1518871573
Provider Name (Legal Business Name): SULLIVAN THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 STATE RD STE 104F
DARTMOUTH MA
02747-3322
US

IV. Provider business mailing address

49 STATE RD STE 104F
DARTMOUTH MA
02747-3322
US

V. Phone/Fax

Practice location:
  • Phone: 774-400-6968
  • Fax:
Mailing address:
  • Phone: 774-400-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: SKYLER EARLE
Title or Position: OWNER
Credential: LICSW
Phone: 774-400-6968