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NPI Code Detail

MEDICARE: MR. JOHN P SULLIVAN LCSW-R

MEDICARE: MR. JOHN P SULLIVAN LCSW-R
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
1104100000XSocial Worker043085NY

General Provider Information

NPI Number : 1073895314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN P SULLIVAN LCSW-R
Provider Business Mailing Address
First Line : 1545 SAINT PAUL ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-3156
Country : US
Telephone Number : 585-286-2824
Fax Number : 585-336-5880
Provider Business Practice Location Address
First Line : 1545 SAINT PAUL ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-3156
Country : US
Telephone Number : 585-286-2824
Fax Number : 585-336-5880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2011
Last Update Date : 09/13/2011

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