Provider Demographics
NPI:1982212023
Name:SULLIVAN, SAMANTHA JOY
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MA
Mailing Address - Zip Code:01503-1001
Mailing Address - Country:US
Mailing Address - Phone:978-514-4863
Mailing Address - Fax:
Practice Address - Street 1:1881 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5410
Practice Address - Country:US
Practice Address - Phone:508-628-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor