MEDICARE: JASMIN LANORA SULLIVAN LMSW

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	124886	NY

General Provider Information

NPI Number	:	1508686650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMIN LANORA SULLIVAN LMSW

Provider Business Mailing Address
First Line	:	999 BLAKE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2581 ATLANTIC AVE FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2412
Country	:	US
Telephone Number	:	718-495-6700
Fax Number	:

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

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	12/04/2025

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