Jacqueline A Sullivan, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

002488 Issued in CT

Practice address

417 Highland Avenue
Suite 1
Waterbury, CT 06708

Phone

(203) 755-9300

Fax

(203) 754-3196

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Child and Adult Psychiatric Services PC

  • Psychiatry Physician
  • Waterbury, CT
  • NPI 1821179516
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245337435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 HIGHLAND AVENUE",
            "address_2": "SUITE 1",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06708",
            "telephone_number": "203-755-9300",
            "fax_number": "203-754-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 HIGHLAND AVENUE",
            "address_2": "SUITE 1",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06708",
            "telephone_number": "203-755-9300",
            "fax_number": "203-754-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "002488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SH",
            "identifier": "140002488CT03",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Sufra
• Stephanie L. Sugin, M.D.
• Hajrie Sulejmani
• Elizabeth Sullivan-Well
• Anna Sullivan, APRN
• Kathleen Lea Sullivan, APRN
• Lindsey Ann Sullivan, MSW,BA
• Meghan Sullivan, RD
• Veronica Sullivan
• William Summa

• Clinical Social Worker in Waterbury, CT
• Providers in Waterbury, 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 Jul 8, 2007; 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.