MEDICARE: ROSEMARY IRENE SULLIVAN L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW3681	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073870770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY IRENE SULLIVAN L.C.S.W.

Provider Business Mailing Address
First Line	:	555 NE 34TH ST
Second Line	:	#2504
City	:	MIAMI
State	:	FL
Zip	:	33137-4022
Country	:	US
Telephone Number	:	305-573-1551
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 NE 34TH ST
Second Line	:	#2504
City	:	MIAMI
State	:	FL
Zip	:	33137-4022
Country	:	US
Telephone Number	:	305-573-1551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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