Kimberly Ann Sullivan, MSW,LICSW,LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1023679 Issued in MA

Practice address

1 W Foster St
3Rd Floor
Melrose, MA 02176-3810

Phone

(781) 308-0868

Fax

(781) 665-0027

NPI assigned

Jul 5, 2006

Last updated

Feb 4, 2025By 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 names 1

• Kimberly Russo Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

• Supportive Behavioral Care of Ma LLC

  • Clinical Psychologist
  • Needham, MA
  • NPI 1780115519
  Medicare reassignment NPD
• Mark Deyab Licsw Inc

  • Clinical Social Worker
  • Melrose, MA
  • NPI 1750715108
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1275564478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W FOSTER ST",
            "address_2": "3RD FLOOR",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021763810",
            "telephone_number": "781-308-0868",
            "fax_number": "781-665-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W FOSTER ST",
            "address_2": "3RD FLOOR",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021763810",
            "telephone_number": "781-308-0868",
            "fax_number": "781-665-0027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MSW,LICSW,LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1023679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "RUSSO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan Angela Stillwell, LICSW
• Julie Stoelzel, MSW, LICSW
• Robert Stoica, PHARMD
• Mary Ramsey Stuckey, PA-C
• Emily C Sullivan
• Mike H Summerer, M.D.
• Madison Summers
• David Summersby, LICSW
• Christi Sung
• George Ara Surabian, DMD

• Clinical Social Worker in Melrose, MA
• Providers in Melrose, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.