Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003151663 |
---|---|
Provider Name | Amy Lee Sullivan |
First Address | Ware, MA 01082-1616 |
Second Address | Ware, MA 01082-1616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 30/05/2013 |