Healthcare Provider Details

I. General information

NPI: 1518280379
Provider Name (Legal Business Name): SULLIVAN CARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 OCEAN HILL DR
KINGSTON MA
02364-3010
US

IV. Provider business mailing address

28 OCEAN HILL DR
KINGSTON MA
02364-3010
US

V. Phone/Fax

Practice location:
  • Phone: 617-910-6078
  • Fax: 781-936-8295
Mailing address:
  • Phone: 617-910-6078
  • Fax: 781-936-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number114273
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number114273
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number114273
License Number StateMA

VIII. Authorized Official

Name: MR. JAMES M SULLIVAN
Title or Position: OWNER
Credential: LICSW
Phone: 617-910-6078