Provider Demographics
NPI:1265581631
Name:SULLIVAN, ELIZABETH ANN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9053 EVANSTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3815
Mailing Address - Country:US
Mailing Address - Phone:206-784-6882
Mailing Address - Fax:206-524-9401
Practice Address - Street 1:8245 20TH AVE NE
Practice Address - Street 2:#4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4407
Practice Address - Country:US
Practice Address - Phone:206-524-9400
Practice Address - Fax:206-524-9401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000050031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical