Robert Dennis Sullivan, LCSW

Primary specialty

CounselorTaxonomy code 101Y00000X

License

605 Issued in AK

Practice address

102 Carlanna Lake Road
Ketchikan, AK 99901

Phone

(907) 225-5576

Fax

(206) 299-4244

NPI assigned

Feb 23, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Robert Dennis Sullivan Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679609911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3183 JACKSON HEIGHTS ST",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015782",
            "telephone_number": "907-225-5576",
            "fax_number": "206-299-4244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 CARLANNA LAKE ROAD",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "99901",
            "telephone_number": "907-225-5576",
            "fax_number": "206-299-4244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "ROBERT",
        "middle_name": "DENNIS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AK",
            "license": "605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERT",
            "last_name": "SULLIVAN",
            "middle_name": "DENNIS",
            "prefix": "MR.",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Counselor in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.