Provider Demographics
NPI:1811597784
Name:SULLIVAN, NADIA (LICSW)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 27TH AVE SE APT 204
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3241
Mailing Address - Country:US
Mailing Address - Phone:734-957-6632
Mailing Address - Fax:
Practice Address - Street 1:250 S 4TH ST # 510
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1321
Practice Address - Country:US
Practice Address - Phone:612-673-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical