NPIMap

Organization Active NPI

Kris Sullivan LCSW

  • Social Worker
  • Bloomington, IN
National Provider Identifier
1487366027
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
KRIS SULLIVAN LCSW
Practice address
3105 S Sare Rd Apt 300
Bloomington, IN 47401-4378
Phone
(812) 333-3939
NPI assigned
Dec 14, 2022
Last updated
Dec 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Authorized official

Name
Kristine Sullivan, LCSWNPI 1851542096
Title
Owner
Phone
(812) 333-3939

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X Primary

Addresses

Primary practice location

3105 S Sare Rd Apt 300
Bloomington, IN 47401-4378

Mailing address

3105 S Sare Rd Apt 300
Bloomington, IN 47401-4378
Phone (812) 333-3939

National Provider Directory

National Provider Directory

Locations

3105 S Sare Rd
Ste 300
Bloomington, IN 47401
Phone (812) 333-3939

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1670976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1487366027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 S SARE RD APT 300",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014378",
            "telephone_number": "812-333-3939",
            "fax_number": "812-585-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 S SARE RD APT 300",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014378",
            "telephone_number": "812-333-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRIS SULLIVAN LCSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-14",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-333-3939",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; 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.