Healthcare Provider Details

I. General information

NPI: 1750904652
Provider Name (Legal Business Name): RORY SULLIVAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date: 05/05/2025
Reactivation Date: 08/15/2025

III. Provider practice location address

89 ACCESS RD STE 24
NORWOOD MA
02062-5233
US

IV. Provider business mailing address

89 ACCESS RD STE 24
NORWOOD MA
02062-5233
US

V. Phone/Fax

Practice location:
  • Phone: 781-336-5040
  • Fax:
Mailing address:
  • Phone: 781-336-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: