Provider Demographics
NPI:1235619453
Name:SULLIVAN, KALLY (LMSW)
Entity Type:Individual
Prefix:
First Name:KALLY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MELBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6626
Mailing Address - Country:US
Mailing Address - Phone:717-215-5303
Mailing Address - Fax:
Practice Address - Street 1:315 MELBOURNE LN
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6626
Practice Address - Country:US
Practice Address - Phone:717-215-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22384104100000X
PASW135540104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker