Provider Demographics
NPI:1205182243
Name:SULLIVAN-BLOCK, CLARE
Entity Type:Individual
Prefix:MISS
First Name:CLARE
Middle Name:
Last Name:SULLIVAN-BLOCK
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 1:172 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7832
Mailing Address - Country:US
Mailing Address - Phone:617-455-5821
Mailing Address - Fax:
Practice Address - Street 1:172 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7832
Practice Address - Country:US
Practice Address - Phone:617-455-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health