Provider Demographics
NPI:1780884940
Name:SULLIVAN, MARY CATHLEEN (MSW/ASW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHLEEN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSW/ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 W PECOS RD APT 3110
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7429
Mailing Address - Country:US
Mailing Address - Phone:408-707-7917
Mailing Address - Fax:
Practice Address - Street 1:575 W PECOS RD APT 3110
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7429
Practice Address - Country:US
Practice Address - Phone:408-707-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor