Miranda Rosemarie Sullivan, LICSW, MHP, SUDPT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61541936 Issued in WA

Practice address

12245 N Park Ave N
Seattle, WA 98133-8026

Phone

(206) 551-1464

NPI assigned

Jun 1, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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.

• Seattle Mental Health Collective

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Seattle, WA
  • NPI 1033951827
  NPD Authorized official

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

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1912521469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12245 N PARK AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338026",
            "telephone_number": "206-551-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12245 N PARK AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338026",
            "telephone_number": "206-551-1464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MIRANDA",
        "middle_name": "ROSEMARIE",
        "credential": "LICSW, MHP, SUDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-01",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO61062660",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61541936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.seattlemhc.com/",
            "affiliation": "N",
            "endpointDescription": "professional website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12245 N Park Ave N",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981338026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew D Sullivan, ND, MSA
• Maureen T. Sullivan, RD
• Micah Sullivan
• Michael Augustus Sullivan
• Michele Marie Sullivan, M.S., LMFT, CMHS
• Norah Mary Sullivan, ARNP
• Patrick Morris Sullivan, M.D.
• Polly A Sullivan, RC
• Sara Zoeann Sullivan, PT
• Scott Jeffrey Sullivan, DDS

• Clinical Social Worker in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.