Healthcare Provider Details

I. General information

NPI: 1912008053
Provider Name (Legal Business Name): KATHLEEN V SULLIVAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WATER ST SUITE B236
PLYMOUTH MA
02360-4060
US

IV. Provider business mailing address

225 WATER ST SUITE B236
PLYMOUTH MA
02360-4060
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-6302
  • Fax: 508-747-6304
Mailing address:
  • Phone: 508-747-6302
  • Fax: 508-747-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number791
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number394A
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: