Provider Demographics
NPI:1295161529
Name:SULLIVAN, LINDSEY ANN (MSW,BA)
Entity type:Individual
Prefix:MISS
First Name:LINDSEY
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSW,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:3RD FLOOR HOME BASED SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-575-0466
Practice Address - Fax:203-575-1817
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT013OtherCONNECTICUT STATE DEPT OF EDUCATION-KINDERGARTEN THRU 6TH GRADE ELEMENTARY
CT071OtherCONNECTICUT STATE DEPT OF EDUCATION-SCHOOL SOCIAL WORKER