Jessica C Sullivan, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R085591 Issued in NY

Practice address

360 State Route 17M
Suite 4
Monroe, NY 10950-3443

Phone

(845) 547-0479

Fax

(845) 547-0479

NPI assigned

Feb 28, 2013

Last updated

Jun 24, 2020By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 28, 2023 through Jun 28, 2027

Medicare enrollment (NPD)

Not 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.

• Jessica C. Sullivan LCSW, PLLC

  dba Nourish Your Mind Counseling & Psychotherapy

  • Clinical Social Worker
  • Monroe, NY
  • NPI 1811532385
  NPD Authorized official
• Nourish Your Mind, LLC

  • Clinical Social Worker
  • Monroe, NY
  • NPI 1649707555
  NPD Authorized official

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1396085304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 STATE ROUTE 17M",
            "address_2": "SUITE 4",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109503443",
            "telephone_number": "845-547-0479",
            "fax_number": "845-547-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 STATE ROUTE 17M",
            "address_2": "SUITE 4",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109503443",
            "telephone_number": "845-547-0479",
            "fax_number": "845-547-0479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Overlook Dr",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "NY",
            "postal_code": "109901810",
            "country_code": "US",
            "telephone_number": "845-547-0479",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "236 Crystal Run Rd",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "NY",
            "postal_code": "109414060",
            "country_code": "US",
            "telephone_number": "845-547-0479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JESSICA",
        "middle_name": "C",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-28",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R085591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Stimpson
• Robert Stoller, RPH
• Joanne Straka, LPN
• Avraham Mendy Strohli, LMSW
• Pessi Stuhl
• Justin Sullivan, DPT
• Victoria Sullivan, LCSW
• Margaret G Summers, RN
• Sunrise Mental Health Counseling, PLLC
• Sunshine Applied Behavior Analysis PLLC

• Clinical Social Worker in Monroe, NY
• Providers in Monroe, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.