MEDICARE: MRS. CARLEY ROWE SULLIVAN MA

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1700130390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLEY ROWE SULLIVAN MA

Provider Business Mailing Address
First Line	:	9015 TOWN CENTER PKWY STE 138
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5012
Country	:	US
Telephone Number	:	757-797-6006
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 TOWN CENTER PKWY STE 138
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5012
Country	:	US
Telephone Number	:	757-797-6006
Fax Number	:

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

Provider Enumeration Date	:	11/03/2012
Last Update Date	:	02/24/2020

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