Patricia Pauline Sullivan, LMSW LMFT DCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801035911 Issued in MI

Practice address

1864 E US 23
Suite B
East Tawas, MI 48730-9349

Phone

(989) 305-6280

NPI assigned

Dec 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319414400000",
    "number": "1639233786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1864 E US 23",
            "address_2": "SUITE B",
            "city": "EAST TAWAS",
            "state": "MI",
            "postal_code": "487309349",
            "telephone_number": "989-305-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1864 E US 23",
            "address_2": "SUITE B",
            "city": "EAST TAWAS",
            "state": "MI",
            "postal_code": "487309349",
            "telephone_number": "989-305-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PATRICIA",
        "middle_name": "PAULINE",
        "name_prefix": "Ms.",
        "credential": "LMSW LMFT DCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2011-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801035911",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MI",
            "license": "4101005476",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeri Nicole Smith
• Leeann Smith
• Michelle St. Aubin, MS, CCC-SLP
• Katherine Olivia Stepp
• Wendy S Strawn, BEHAVIOR TECHNICIAN
• Jennifer Sylvester, RN
• Tawas Bay Optical Inc.
• Andrew Rance Vanvlerah
• David Wajda, BEHAVIOR TECHNICIAN
• Lindsey Walters, BEHAVIOR TECHNICIAN

• Clinical Social Worker in East Tawas, MI
• Providers in East Tawas, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.