Provider Demographics
NPI:1568503233
Name:SULLIVAN, LINDA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
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 1:3001 LEAF LN
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1628
Mailing Address - Country:US
Mailing Address - Phone:215-410-6151
Mailing Address - Fax:610-948-9001
Practice Address - Street 1:3001 LEAF LN
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1628
Practice Address - Country:US
Practice Address - Phone:215-410-6151
Practice Address - Fax:610-948-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7595764OtherAETNA
PA815798000OtherMAGELLAN
PA2633545000OtherPERSONAL CHOICE