MEDICARE: MS. DEVON SULLIVAN

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	135637	CA

General Provider Information

NPI Number	:	1720481294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEVON SULLIVAN

Provider Business Mailing Address
First Line	:	2009A PALO VERDE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3322
Country	:	US
Telephone Number	:	562-743-2389
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009A PALO VERDE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3322
Country	:	US
Telephone Number	:	562-743-2389
Fax Number	:

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	01/13/2026

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