Healthcare Provider Details

I. General information

NPI: 1740592955
Provider Name (Legal Business Name): MARY ELIZABETH SULLIVAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SOUTH 17TH STREET
LINCOLN NE
68502-2953
US

IV. Provider business mailing address

2201 SOUTH 17TH STREET
LINCOLN NE
68502-2953
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-7940
  • Fax: 402-441-8625
Mailing address:
  • Phone: 402-441-7940
  • Fax: 402-441-8625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: