Provider Demographics
NPI:1952469884
Name:O'SULLIVAN, MARY ELLEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 ADAMS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1746
Mailing Address - Country:US
Mailing Address - Phone:978-251-7337
Mailing Address - Fax:978-251-8453
Practice Address - Street 1:10 ADAMS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1746
Practice Address - Country:US
Practice Address - Phone:978-251-7337
Practice Address - Fax:978-251-8453
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO3374Medicare ID - Type UnspecifiedPSYCHOLOGY PROVIDER