MEDICARE: DANI SULLIVAN LCSW, MSW

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	149025928	IL
2	1041C0700X	Clinical Social Worker	SW21151	FL

General Provider Information

NPI Number	:	1144078395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANI SULLIVAN LCSW, MSW

Provider Business Mailing Address
First Line	:	680 N GREEN ST APT 306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5977
Country	:	US
Telephone Number	:	561-702-1184
Fax Number	:

Provider Business Practice Location Address
First Line	:	6586 ATLANTIC AVE # 1136
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-1617
Country	:	US
Telephone Number	:	561-425-8647
Fax Number	:

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

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	05/10/2024

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