Provider Demographics
NPI:1114931706
Name:SULLIVAN, SARA NIVENS (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:NIVENS
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:COLLEEN
Other - Last Name:NIVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:7629 VELVET MIST ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3651
Mailing Address - Country:US
Mailing Address - Phone:702-939-8556
Mailing Address - Fax:
Practice Address - Street 1:7629 VELVET MIST ST.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3651
Practice Address - Country:US
Practice Address - Phone:702-939-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4914-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker