Provider Demographics
NPI:1215294699
Name:SULLIVAN, ERIN KATHLEEN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FRANKLIN AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1060
Mailing Address - Country:US
Mailing Address - Phone:410-973-2525
Mailing Address - Fax:410-973-2527
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1060
Practice Address - Country:US
Practice Address - Phone:410-973-2525
Practice Address - Fax:410-973-2527
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical