MEDICARE: MELISSA MARIE 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	113791	MA

General Provider Information

NPI Number	:	1740571702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARIE SULLIVAN

Provider Business Mailing Address
First Line	:	1 CARMA LN
Second Line	:
City	:	BERKLEY
State	:	MA
Zip	:	02779-1426
Country	:	US
Telephone Number	:	774-766-9490
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 TAUNTON GRN STE 204
Second Line	:
City	:	TAUNTON
State	:	MA
Zip	:	02780-3252
Country	:	US
Telephone Number	:	774-765-9490
Fax Number	:

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

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	05/27/2026

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