Kenna M. Sullivan, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

107098 Issued in MA

Practice address

692 Washington St
Brighton, MA 02135-1537

Phone

(617) 312-8067

Fax

(617) 254-9479

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ksullivan240297@direct.bmc.masshiway.net

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

• Boston Medical Center Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1346218294
  NPD
• Advanced Wound Recovery - Boston, LLC

  dba Advanced Wound Recovery of Boston

  • Internal Medicine Physician
  • Waltham, MA
  • NPI 1316958150
  NPD (past)
• Boston Neurobehavioral Associates, LLC

  • Psychiatry Physician
  • New Bedford, MA
  • NPI 1558415307
  NPD (past)

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1942410402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE STE 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692 WASHINGTON ST",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021351537",
            "telephone_number": "617-312-8067",
            "fax_number": "617-254-9479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Boston Medical Ctr Pl",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182908",
            "country_code": "US",
            "telephone_number": "617-414-5245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KENNA",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "107098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1854526",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "62-00541",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trevor Sullivan-Smith
• Catherine W Sullivan, LICSW
• Jennifer Sullivan, OTR/L
• John G Sullivan, MD
• Kara Elisabeth Sullivan, OTR/L
• Sarah Sullivan
• Mark Ihab Sultan, MD
• Mengyue Sun
• Azadeh Suppappola, O.D.
• Andrea L Susi, PHARMD, RPH

• Clinical Social Worker in Brighton, MA
• Providers in Brighton, MA by specialty
• Clinical Social Worker in Massachusetts

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