Active NPI
Andrea Sullivan
- Clinical Social Worker
- Santa Rosa, CA
National Provider Identifier
1518739606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ASW112006
- Practice address
- 2403 Professional Dr Ste 101
Santa Rosa, CA 95403-3007 - Phone
- (707) 544-3295
- NPI assigned
- Oct 23, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ASW112006 | CA | Primary |
Addresses
Primary practice location
2403 Professional Dr Ste 101
Santa Rosa, CA 95403-3007
Mailing address
2403 Professional Dr Ste 101
Santa Rosa, CA 95403-3007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW112006 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698019200000",
"number": "1518739606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2403 PROFESSIONAL DR STE 101",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2403 PROFESSIONAL DR STE 101",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033007",
"telephone_number": "707-544-3295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ANDREA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-23",
"last_updated": "2023-10-23",
"certification_date": "2023-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW112006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.