Provider Demographics
NPI:1386020196
Name:SULLIVAN, JENEVIEVE L (MS)
Entity Type:Individual
Prefix:
First Name:JENEVIEVE
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:EASTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06242-0263
Mailing Address - Country:US
Mailing Address - Phone:860-377-2131
Mailing Address - Fax:
Practice Address - Street 1:35 SOCKANOSSET CROSS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5535
Practice Address - Country:US
Practice Address - Phone:401-383-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health