Antoinette O Sullivan, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01516 Issued in RI

Practice address

65 Village Square Dr
South Kingstown, RI 02879-2292

Phone

(401) 789-5924

Fax

(401) 782-1770

NPI assigned

Feb 7, 2007

Last updated

Apr 9, 2024By the provider in NPPES

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 names 1

• Antoinette O'Brien Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in RI

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

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.

• Coastal Medical Physicians, Inc.

  dba Brown Health Medical Group Primary Care

  • Internal Medicine Physician
  • Providence, RI
  • NPI 1780273540

  Clinical

  Medicare reassignment NPD
• Coastal Medical Physicians, Inc.

  dba Brown Health Medical Group Primary Care

  • Internal Medicine Physician
  • Riverside, RI
  • NPI 1093678104

  Clinical

  NPD

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1366582819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DAVOL SQ",
            "address_2": "SUITE 400",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034754",
            "telephone_number": "401-421-4000",
            "fax_number": "401-272-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 VILLAGE SQUARE DR",
            "city": "SOUTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028792292",
            "telephone_number": "401-789-5924",
            "fax_number": "401-782-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "ANTOINETTE",
        "middle_name": "O",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asullivan221078@direct.lifespan.org",
            "affiliation": "N",
            "address_1": "65 Village Square Dr",
            "city": "South Kingstown",
            "state": "RI",
            "country_code": "US",
            "postal_code": "028792292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANTOINETTE",
            "last_name": "O'BRIEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• South Bay Manor
• South County Speech Therapy LLC
• Bethany Rachael Spadaro, RPH
• Michael Starkey, PH.D.
• Amanda Stevens
• Nicole B Swanson, LICSW
• Therapediatrics Inc.
• Together With Tech LLC
• Allison Torti, LMHC
• Michael Scott Trazi, PMHNP-BC

• Clinical Social Worker in South Kingstown, RI
• Providers in South Kingstown, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.