Jennifer Marie Sullivan-Brunault, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113195 Issued in MA

Practice address

335 Walnut St. Extension, Suite 200
Agawam Professional Center
Agawam, MA 01001-1524

Phone

(413) 789-8955

Fax

(413) 789-0557

NPI assigned

Dec 27, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Jennifer Marie Sullivan Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Deborah Hunter, LMHC

  • Mental Health Counselor
  • Agawam, MA
  • NPI 1841530839
  NPD (past)
• The New England Center for Marriage and Family Therapy

  • Community/Behavioral Health Agency
  • Agawam, MA
  • NPI 1497955488
  NPD (past)

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

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1750650487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 WALNUT ST. EXTENSION, SUITE 200",
            "address_2": "AGAWAM PROFESSIONAL CENTER",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010011524",
            "telephone_number": "413-789-8955",
            "fax_number": "413-789-0557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 WALNUT ST. EXTENSION, SUITE 200",
            "address_2": "AGAWAM PROFESSIONAL CENTER",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010011524",
            "telephone_number": "413-789-8955",
            "fax_number": "413-789-0557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN-BRUNAULT",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SULLIVAN",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• James L Splain, MD
• Gina Rose Stafilarakis
• Michelle M Stevens, OTR
• Cheryl Beth Stone-Phillips, PTA
• Robin Sudlow
• Sunshine Village
• Anna Swiader-Bouniconti, PHYSICAL THERAPIST
• Martin Talia, DDS
• Tender Loving Care Health Care Services of New England, L.L.C.
• Tender Loving Care Health Care Services of New England, LLC

• All providers in Agawam, MA
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; 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.