Active NPI
Robert Allen Sullivan, LICSW
- Clinical Social Worker
- Coon Rapids, MN
National Provider Identifier
1548224355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 8
- Practice address
- 1930 Coon Rapids Blvd
Family Life Mental Health Center
Coon Rapids, MN 55433 - Phone
- (763) 427-7964
- Fax
- (763) 427-7976
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- 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 | 8 | MN | Primary |
Addresses
Primary practice location
1930 Coon Rapids Blvd
Family Life Mental Health Center
Coon Rapids, MN 55433
Mailing address
1930 Coon Rapids Blvd
Family Life Mental Health Center
Coon Rapids, MN 55433
Phone (763) 746-9583
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HP17514 | Other | HEALTH PARTNERS | |
| 6200879 | Other | UBH | |
| 106772 | Other | UCARE | |
| 32A98SU | Other | MN | BCBS |
| 1023456 | Other | MN | PREFERRED ONE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1548224355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 COON RAPIDS BLVD",
"address_2": "FAMILY LIFE MENTAL HEALTH CENTER",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "55433",
"telephone_number": "763-746-9583",
"fax_number": "763-746-9597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1930 COON RAPIDS BLVD",
"address_2": "FAMILY LIFE MENTAL HEALTH CENTER",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "55433",
"telephone_number": "763-427-7964",
"fax_number": "763-427-7976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ROBERT",
"middle_name": "ALLEN",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "8",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP17514",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "6200879",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "106772",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "32A98SU",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1023456",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.