Mary M Sullivan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

005814 Issued in CT

Practice address

132 E Putnam Ave
Suite H
Cos Cob, CT 06807-2744

Phone

(203) 962-2209

Fax

(203) 962-2209

NPI assigned

Jun 29, 2006

Last updated

Jun 6, 2011By 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

Other identifiers 2

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

• Cos Cob Counseling Center

  • Clinical Social Worker
  • Cos Cob, CT
  • NPI 1275814147
  NPD (past) Authorized official

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307318400000",
    "number": "1174551030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 E PUTNAM AVE",
            "city": "COS COB",
            "state": "CT",
            "postal_code": "068072744",
            "telephone_number": "203-962-2209",
            "fax_number": "203-962-2209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 E PUTNAM AVE",
            "address_2": "SUITE H",
            "city": "COS COB",
            "state": "CT",
            "postal_code": "068072744",
            "telephone_number": "203-962-2209",
            "fax_number": "203-962-2209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARY",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2011-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "005814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004172920",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004172912",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shore Endodontics
• Pamela Gail Sperling, MA, EDM, LPC
• Jaime Sternberg, DPT
• Daniel Stroup III, LMT
• Daeyoung Sullivan, L.AC
• Mark Robert Sutton, DDS
• Sean Sutton, D.D.S.
• Clare Burke Swanson
• Kenneth Barry Temple, DDS
• Jill V. Tesei, A.P.R.N.

• Clinical Social Worker in Cos Cob, CT
• Providers in Cos Cob, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; 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.