Mary Katherine Elizabeth Sullivan, LCSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5027C Issued in AL

Practice address

1204 Vendome Dr W
Mobile, AL 36609-3326

Phone

(504) 345-8537

NPI assigned

Jul 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in AL, TX, DC, LA4 enrollments

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.

Enrollment records 4

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mk.sullivan.1@24284.direct.athenahealth.com

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, DC, LA, TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1881267540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 VENDOME DR W",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366093326",
            "telephone_number": "504-345-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 VENDOME DR W",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366093326",
            "telephone_number": "504-345-8537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARY KATHERINE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "LCSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-21",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "5027C",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904016013",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "15192",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "112281",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Hare Sugg Jr., MD
• Martha L Sullins, D MIN.,LPC
• Brian Patrick Sullivan, M.D.
• Kirstan Sullivan
• Linda Sullivan, CRNP
• Rogan Sullivan
• Timmany Sullivan
• Tyler Olivia Sumner, PA-C
• Carol Barbour Sumrall, LPC
• Sunbelt Patient Solutions LLC

• Clinical Social Worker in Mobile, AL
• Providers in Mobile, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.