Jacquelyn Ruth Sullivan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

071014 Issued in NY

Practice address

76 Main Street
Suite B
Sidney, NY 13838

Phone

(607) 563-4080

Fax

(607) 336-7326

NPI assigned

Sep 13, 2006

Last updated

Jul 27, 2011By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Specialty

Clinical Social Worker

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Catholic Charities of Chenango County

  • Mental Illness Community Based Residential Treatment Facility
  • Norwich, NY
  • NPI 1285027458
  NPD (past)
• Chenango County Catholic Charities

  dba Catholic Charities of Chenango County

  • Voluntary or Charitable Agency
  • Norwich, NY
  • NPI 1447318662
  NPD (past)
• Davis and Nezelek Clinical Counseling

  • Clinical Social Worker
  • Sidney, NY
  • NPI 1851514178
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311724800000",
    "number": "1952406282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1046",
            "address_2": "ATTN: SALLY FOLLETT-BILLING SERVICES",
            "city": "NORWICH",
            "state": "NY",
            "postal_code": "13815",
            "telephone_number": "607-334-5010",
            "fax_number": "607-336-7326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 MAIN STREET",
            "address_2": "SUITE B",
            "city": "SIDNEY",
            "state": "NY",
            "postal_code": "13838",
            "telephone_number": "607-563-4080",
            "fax_number": "607-336-7326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELYN",
        "middle_name": "RUTH",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2011-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "071014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP MOHAWK VALLEY PLAN",
            "identifier": "713668",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Elaine Smith, RN
• Julie Marie Stark, DOCTOR OF PHARMACY
• Shannon Gail Stark, M.A. CCC/SLP, NP-C
• Jennifer Steele
• Stephen S. Benham,MDPC
• Amelia Sutphin
• Lutfallah T Swabini, RPH
• Joseph Michael Tabone, DC
• Leibing Tang, M.D.
• Dawn Thayer

• Clinical Social Worker in Sidney, NY
• Providers in Sidney, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.