MEDICARE: KRISTEN SULLIVAN LMHC

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	101YM0800X	Mental Health Counselor	7226	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265692990	OTHER		NPI

General Provider Information

NPI Number	:	1821468737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN SULLIVAN LMHC

Provider Business Mailing Address
First Line	:	844 FRANKLIN ST UNIT 8
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1223
Country	:	US
Telephone Number	:	774-847-9650
Fax Number	:

Provider Business Practice Location Address
First Line	:	844 FRANKLIN ST UNIT 8
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1223
Country	:	US
Telephone Number	:	774-847-9650
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTEN SULLIVAN
Credential	:	LMHC
Telephone Number	:	781-760-4944

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	10/05/2015

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