Jeremy Ray Sullivan, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

04800000878 Issued in VT

Practice address

77 Hospital Ave Ste 214
North Adams, MA 01247-2538

Phone

(413) 398-5064

Fax

(413) 398-5496

NPI assigned

Aug 5, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medoptions of Vermont LLC

  • Psychiatry Physician
  • Barre, VT
  • NPI 1114479730

  Clinical

  Medicare reassignment NPD
• Williamstown Behavioral Health Associates

  • Psychologist
  • North Adams, MA
  • NPI 1417023672

  Clinical

  NPD Authorized official
• Williamstown Behavioral Health Associates

  • Speech-Language Pathologist
  • North Adams, MA
  • NPI 1821664228
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1043441306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 MAPLE ST",
            "city": "NORTH ADAMS",
            "state": "MA",
            "postal_code": "012472828",
            "telephone_number": "413-347-6679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 HOSPITAL AVE STE 214",
            "city": "NORTH ADAMS",
            "state": "MA",
            "postal_code": "012472538",
            "telephone_number": "413-398-5064",
            "fax_number": "413-398-5496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JEREMY",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-05",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "04800000878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carmen Judith Soto Gonzalez
• Sound Physicians of Massachusetts Inc
• Kari Squires, FNP
• Stop and Shop Supermarket Co LLC
• Mary E Sugden, CADACII, LADCI, CCS
• Surgimed Corporation
• Marifuddin Hussaini Syed, DENTIST
• Shaohua Tang, M.D.
• Tanzman, Maselli & Associates, P.C.
• Tapestry Health Systems

• Clinical Psychologist in North Adams, MA
• Providers in North Adams, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.