Provider Demographics
NPI:1043431919
Name:ODETTE OSULLIVAN, AIMEE CAROL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:CAROL
Last Name:ODETTE OSULLIVAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:CAROL
Other - Last Name:OSULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3509
Mailing Address - Country:US
Mailing Address - Phone:941-487-5410
Mailing Address - Fax:941-487-5430
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-487-5400
Practice Address - Fax:941-487-5430
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL755630600Medicaid