MEDICARE: SARA SULLIVAN MA, LCMHC

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	101YM0800X	Mental Health Counselor

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	:	1184950941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA SULLIVAN MA, LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 2063
Second Line	:
City	:	DOVER
State	:	NH
Zip	:	03821-2063
Country	:	US
Telephone Number	:	617-302-6278
Fax Number	:	617-302-6278

Provider Business Practice Location Address
First Line	:	90 WASHINGTON ST
Second Line	:
City	:	DOVER
State	:	NH
Zip	:	03820-3744
Country	:	US
Telephone Number	:	617-302-6278
Fax Number	:	617-302-6278

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

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	12/02/2014

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