Healthcare Provider Details

I. General information

NPI: 1386351419
Provider Name (Legal Business Name): SKYLER SULLIVAN EARLE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 STATE RD
NORTH DARTMOUTH MA
02747-3322
US

IV. Provider business mailing address

49 STATE RD NAUSET BUILDING SUITE 104F
DARTMOUTH MA
02747-3322
US

V. Phone/Fax

Practice location:
  • Phone: 617-524-4620
  • Fax:
Mailing address:
  • Phone: 508-991-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1142599
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: