Provider Demographics
NPI:1003432139
Name:SULLIVAN, ANNA FRANCES
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:FRANCES
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95A PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-3112
Mailing Address - Country:US
Mailing Address - Phone:203-312-3889
Mailing Address - Fax:
Practice Address - Street 1:95A PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-3112
Practice Address - Country:US
Practice Address - Phone:203-312-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor