Healthcare Provider Details

I. General information

NPI: 1255394359
Provider Name (Legal Business Name): ELIZABETH SULLIVAN PSY.D., LMHC, LMET
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FEDERAL ST SUITE B
SALEM MA
01970-3869
US

IV. Provider business mailing address

PO BOX 2190
WEST PEABODY MA
01960-7190
US

V. Phone/Fax

Practice location:
  • Phone: 617-967-0707
  • Fax:
Mailing address:
  • Phone: 781-231-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3453
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: