MEDICARE: ELIZABETH SULLIVAN 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	104100000X	Social Worker	102632	NY

General Provider Information

NPI Number	:	1447907860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SULLIVAN LCSW

Provider Business Mailing Address
First Line	:	83 HOLCROFT RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14612-5721
Country	:	US
Telephone Number	:	585-727-5885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 CHILI AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3334
Country	:	US
Telephone Number	:	585-727-5885
Fax Number	:

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

Provider Enumeration Date	:	03/05/2022
Last Update Date	:	02/18/2023

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