MEDICARE: HOLLY ANN SULLIVAN MSW, LCSW

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

General Provider Information

NPI Number	:	1346422011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY ANN SULLIVAN MSW, LCSW

Provider Business Mailing Address
First Line	:	34406 N. 27TH DRIVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085
Country	:	US
Telephone Number	:	602-492-1886
Fax Number	:

Provider Business Practice Location Address
First Line	:	34406 N 27TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-6082
Country	:	US
Telephone Number	:	602-492-1886
Fax Number	:

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

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	07/21/2022

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