Healthcare Provider Details

I. General information

NPI: 1871604884
Provider Name (Legal Business Name): BEVERLY K SULLIVAN L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 3RD ST
BEAVER PA
15009-2302
US

IV. Provider business mailing address

1840 TUSCARAWAS RD
BEAVER PA
15009-1148
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-6670
  • Fax: 724-728-5570
Mailing address:
  • Phone: 724-728-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW004925E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: