| Jeanne Sullivan Licsw Llc | |
|
39 Woodbury Rd Burlington VT 05408-5723 | |
| (802) 999-5100 | |
| Not Available |
| Full Name | Jeanne Sullivan Licsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 39 Woodbury Rd, Burlington, Vermont |
| Authorized Official Name and Position | Jeanne M Sullivan (SOLE PROPRIETOR) |
| Authorized Official Contact | 8029995100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeanne Sullivan Licsw Llc 39 Woodbury Rd Burlington VT 05408-5723 Ph: (802) 999-5100 | Jeanne Sullivan Licsw Llc 39 Woodbury Rd Burlington VT 05408-5723 Ph: (802) 999-5100 |
| NPI Number | 1972191534 |
|---|---|
| Provider Enumeration Date | 01/08/2021 |
| Last Update Date | 01/08/2021 |
| Certification Date | 01/08/2021 |
| Medicare PECOS PAC ID | 6204242092 |
|---|---|
| Medicare Enrollment ID | O20210302002021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972191534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jeanne M Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851685515 PECOS PAC ID: 3678989696 Enrollment ID: I20210316003005 |
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