Provider Demographics
NPI:1326460320
Name:SULLIVAN, SUMING (LICSW)
Entity Type:Individual
Prefix:
First Name:SUMING
Middle Name:
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 1:661 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5000
Mailing Address - Country:US
Mailing Address - Phone:617-702-4710
Mailing Address - Fax:
Practice Address - Street 1:661 MASSCAHUSETTS AVENUE
Practice Address - Street 2:SUITE 21
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476
Practice Address - Country:US
Practice Address - Phone:617-702-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1178431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical