Provider Demographics
NPI:1427332279
Name:SULLIVAN, ALYSON NICOLE (BA)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:NICOLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 UNION ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1434
Mailing Address - Country:US
Mailing Address - Phone:781-956-0874
Mailing Address - Fax:
Practice Address - Street 1:549 COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1138
Practice Address - Country:US
Practice Address - Phone:781-556-5172
Practice Address - Fax:781-749-3873
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health