Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | Q1-0000769 | DE |
NPI | 1003051244 |
---|---|
Provider Name | Mrs. Leah Denise Sullivan |
First Address | Dover, DE 19901-7314 |
Second Address | Dover, DE 19904-6600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2008 |
Last Update Date | 21/05/2018 |