Keesha Monaie Sullivan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW11227 Issued in FL

Practice address

4100 W Kennedy Blvd
Suite 327
Tampa, FL 33609-2288

Phone

(727) 692-7364

NPI assigned

Mar 20, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• An Awakened Heart Psychological Approaches Tomentalhealth Wellness LLC

  • Community/Behavioral Health Agency
  • Tampa, FL
  • NPI 1841639929
  NPD (past) Authorized official

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367452800000",
    "number": "1053653840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8450 112TH ST.",
            "address_2": "UNIT 104",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724221",
            "telephone_number": "727-692-7364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 W KENNEDY BLVD",
            "address_2": "SUITE 327",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336092288",
            "telephone_number": "727-692-7364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KEESHA",
        "middle_name": "MONAIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-20",
        "last_updated": "2013-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW11227",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "070494",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Sullivan
• Jillian Sullivan
• Johanna Lydia Sullivan, PHARM.D.
• Kaitlin Rose Sullivan, BCABA
• Katelyn Sullivan
• Kira Sullivan, AUD
• Krista Sullivan, RMHCI, CRC
• Laurie Sullivan, ARNP
• Lisa Otero Sullivan, MA, LMFT
• Megan Catherine Sullivan, AU.D.

• Clinical Social Worker in Tampa, FL
• Providers in Tampa, 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 May 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.