Provider Demographics
NPI:1205167681
Name:SULLIVAN, GRETCHEN ANN (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MS
Other - First Name:GRETCHEN
Other - Middle Name:ANN
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:73 MOUNTAIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1801
Mailing Address - Country:US
Mailing Address - Phone:508-224-7840
Mailing Address - Fax:508-224-7840
Practice Address - Street 1:42 HILLER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770-4023
Practice Address - Country:US
Practice Address - Phone:508-763-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health