Melinda Jean Sullivan, LCSW LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

006460 Issued in CT

Practice address

97 South St Ste 105
West Hartford, CT 06110-1964

Phone

(860) 559-6922

NPI assigned

Jul 25, 2007

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

Enrolled in CT

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

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Group practices

Peaceful Mind Behavioral Health and Wellness LLCGroup PAC ID 0941683056, 15 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Peaceful Mind Behavioral Health & Wellness, LLC

  • Mental Health Counselor
  • Bristol, CT
  • NPI 1255926358

  Clinical

  Medicare reassignment Care Compare group NPD
• Peaceful Mind Behavioral Health & Wellness, LLC

  • Mental Health Counselor
  • Bristol, CT
  • NPI 1275321846

  Clinical

  NPD

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1295925485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 SOUTH ST STE 105",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061101964",
            "telephone_number": "860-559-6922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 SOUTH ST STE 105",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061101964",
            "telephone_number": "860-559-6922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MELINDA",
        "middle_name": "JEAN",
        "credential": "LCSW LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-25",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonard C Suchotliff, PHD
• Amanda Kate Sullivan
• Emily Sullivan
• Emily Ricker Sullivan, M ED., BCBA
• Sullivan, Lemay & Associates Behavioral Health & Wellness LLC
• Paul Ryan Charles Sullivan, MD
• Paul S Sullivan, D.O.
• Summit Wellness Counseling LLC
• Daniel Kenneth Sunderland, DO
• Susan Bernstein, LCSW, Licsw, LLC

• Clinical Social Worker in West Hartford, CT
• Providers in West Hartford, 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 Mar 22, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.