Active NPI
Diane Louise Sullivan
- Social Worker
- Ithaca, NY
National Provider Identifier
1013978642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- R039539-1
- Practice address
- Cornell University Health Services
Ho Plaza
Ithaca, NY 14853-3101 - Phone
- (607) 255-6946
- Fax
- (607) 254-3503
- NPI assigned
- Mar 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | R039539-1 | NY | Primary |
Addresses
Primary practice location
Cornell University Health Services
Ho Plaza
Ithaca, NY 14853-3101
Mailing address
Cornell University Health Services
Ho Plaza
Ithaca, NY 14853-3101
Phone (607) 255-6946
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151125000879 | NY | Practitioner - Clinical Social Worker | 2567762453 | Practice locations: Ithaca, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1988
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
416 N Tioga St
Ithaca, NY 14850-4368
Phone (607) 592-2553
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R039539-1 | NY | MD | Social Worker |
| 039539 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1013978642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CORNELL UNIVERSITY HEALTH SERVICES",
"address_2": "HO PLAZA",
"city": "ITHACA",
"state": "NY",
"postal_code": "148533101",
"telephone_number": "607-255-6946",
"fax_number": "607-254-3503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CORNELL UNIVERSITY HEALTH SERVICES",
"address_2": "HO PLAZA",
"city": "ITHACA",
"state": "NY",
"postal_code": "148533101",
"telephone_number": "607-255-6946",
"fax_number": "607-254-3503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "DIANE",
"middle_name": "LOUISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-31",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "R039539-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.