Provider Demographics
NPI:1255394359
Name:SULLIVAN, ELIZABETH (PSYD, LMHC, LMET)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PSYD, LMHC, LMET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:WEST PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7190
Mailing Address - Country:US
Mailing Address - Phone:781-231-7026
Mailing Address - Fax:
Practice Address - Street 1:30 FEDERAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3869
Practice Address - Country:US
Practice Address - Phone:617-967-0707
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3453101YM0800X
MA922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14956OtherHARVARD PILGRIM HEALTHCAR
MALM0037OtherBCBS
MA458376OtherTUFTS