Provider Demographics
NPI:1548430986
Name:SULLIVAN, KATHERINE MICHELE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MICHELE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SHORT HILL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-2508
Mailing Address - Country:US
Mailing Address - Phone:914-417-1356
Mailing Address - Fax:
Practice Address - Street 1:215 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3210
Practice Address - Country:US
Practice Address - Phone:203-454-2428
Practice Address - Fax:203-454-2447
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical