Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003007212 |
---|---|
Provider Name | Erin Elizabeth Sullivan |
First Address | Saugus, MA 01906-2851 |
Second Address | Brockton, MA 02301-5596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 14/08/2007 |