Provider Demographics
NPI:1336949015
Name:OSULLIVAN, TERRI-ANN GEORGIANN (LCSW)
Entity type:Individual
Prefix:
First Name:TERRI-ANN
Middle Name:GEORGIANN
Last Name:OSULLIVAN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21924 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2607
Mailing Address - Country:US
Mailing Address - Phone:646-342-1753
Mailing Address - Fax:
Practice Address - Street 1:21924 113TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2607
Practice Address - Country:US
Practice Address - Phone:646-342-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610852163WG0000X
NY0733321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice