1609961630 NPI number — MS. MARY E SULLIVAN LCSW

Table of content: MS. MARY E SULLIVAN LCSW (NPI 1609961630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609961630 NPI number — MS. MARY E SULLIVAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609961630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
HIGHTSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08520-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-443-3970
Provider Business Mailing Address Fax Number:
609-443-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HIGHTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08520-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-443-3970
Provider Business Practice Location Address Fax Number:
609-443-8029
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04326100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 167870 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6276254 . This is a "UNITED BEH HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P809023 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11626 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138555000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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