Provider Demographics
NPI:1447765854
Name:SULLIVAN, MAUREEN ROSE
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ROSE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2033
Mailing Address - Country:US
Mailing Address - Phone:808-345-8477
Mailing Address - Fax:
Practice Address - Street 1:32 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2033
Practice Address - Country:US
Practice Address - Phone:808-345-8477
Practice Address - Fax:808-345-8477
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty