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General NPI Number Information
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NPI Number | 1194814988
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Entity Type | Individual
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Provider Name | JOYCE ANN SULLIVAN MA, LADAC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 167 MAIN ST STE 401
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City | BRATTLEBORO
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State | VT
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Zip | 05301-3017
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Country | US
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Telephone | 802-376-5076
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Fax |
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Provider Business Mailing Address
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Address Line | 44 NORTH ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6000
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Country | US
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Telephone | 802-376-5076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0680000316
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 047-0000661
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License Number State | VT
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