Provider Demographics
NPI:1780057695
Name:SULLIVAN, JANE SARNO (LICSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:SARNO
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EDGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-5699
Mailing Address - Country:US
Mailing Address - Phone:508-693-7900
Mailing Address - Fax:508-696-0401
Practice Address - Street 1:111 EDGARTOWN RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5699
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:508-696-0401
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1189121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical