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General NPI Number Information
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NPI Number | 1609961630
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Entity Type | Individual
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Provider Name | MARY E SULLIVAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 102 MAIN ST SUITE 1
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City | HIGHTSTOWN
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State | NJ
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Zip | 08520-4800
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Country | US
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Telephone | 609-443-3970
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Fax | 609-443-8029
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Provider Business Mailing Address
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Address Line | 102 MAIN ST SUITE 1
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City | HIGHTSTOWN
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State | NJ
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Zip | 08520-4800
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Country | US
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Telephone | 609-443-3970
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Fax | 609-443-8029
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04326100
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License Number State | NJ
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