Provider Demographics
NPI:1326051855
Name:SULLIVAN, JON J (MSSW)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WASHINGTON ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3518
Mailing Address - Country:US
Mailing Address - Phone:978-741-0611
Mailing Address - Fax:978-741-8982
Practice Address - Street 1:70 WASHINGTON ST
Practice Address - Street 2:SUITE 316
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3518
Practice Address - Country:US
Practice Address - Phone:978-741-0611
Practice Address - Fax:978-741-8982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW 1023391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical