Provider Demographics
NPI:1811522683
Name:O'SULLIVAN, JEANMARIE (MSW)
Entity type:Individual
Prefix:
First Name:JEANMARIE
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SLATERS LN APT 506
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1126
Mailing Address - Country:US
Mailing Address - Phone:703-618-5701
Mailing Address - Fax:
Practice Address - Street 1:105 ORONOCO ST STE 305
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2089
Practice Address - Country:US
Practice Address - Phone:703-618-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker