Patricia Ellen Sullivan

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

3441 Colonial Blvd Ste 2
Fort Myers, FL 33966-1121

Phone

(239) 878-7895

NPI assigned

Oct 24, 2022

Last updated

Apr 8, 2024By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mindful Journey Therapy LLC

  • Clinical Social Worker
  • Fort Myers, FL
  • NPI 1598473902
  NPD Authorized official

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1053038661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3441 COLONIAL BLVD STE 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661121",
            "telephone_number": "239-878-7895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3441 COLONIAL BLVD STE 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661121",
            "telephone_number": "239-878-7895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PATRICIA",
        "middle_name": "ELLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-24",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Sullivan, M.A., M.F.T.
• Clarissa Sullivan
• John Patrick Sullivan, M.D.
• Leia Sullivan, PAC
• Lisa A Sullivan, C.R.N.A.
• Sara Sullivan
• Sarah Sullivan
• Shahid Sultan, M.D.
• Emily Ann Summa, OTR/L
• Summerlin Anesthesia, Inc.

• Clinical Social Worker in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.