Provider Demographics
NPI:1659491652
Name:SULLIVAN, LAURIE ANN (MA, ,LMHC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, ,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1592
Mailing Address - Country:US
Mailing Address - Phone:150-824-0009
Mailing Address - Fax:150-825-5131
Practice Address - Street 1:3937 MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1592
Practice Address - Country:US
Practice Address - Phone:150-824-0009
Practice Address - Fax:150-825-5131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health