Provider Demographics
NPI:1306181631
Name:SULLIVAN, MARGARET MARY (LICSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 MAIN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3314
Mailing Address - Country:US
Mailing Address - Phone:315-707-4186
Mailing Address - Fax:
Practice Address - Street 1:486 MAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3314
Practice Address - Country:US
Practice Address - Phone:315-707-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1163401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical