Healthcare Provider Details

I. General information

NPI: 1497644694
Provider Name (Legal Business Name): MELISSA SULLIVAN, LICSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 09/11/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 TAUNTON GRN STE 204
TAUNTON MA
02780-3252
US

IV. Provider business mailing address

1 CARMA LN
BERKLEY MA
02779-1426
US

V. Phone/Fax

Practice location:
  • Phone: 508-386-3077
  • Fax:
Mailing address:
  • Phone: 508-954-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA SULLIVAN
Title or Position: OWNER
Credential: MSW
Phone: 508-954-2472