Provider Demographics
NPI:1497644694
Name:MELISSA SULLIVAN, LICSW PC
Entity type:Organization
Organization Name:MELISSA SULLIVAN, LICSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:508-954-2472
Mailing Address - Street 1:1 CARMA LN
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1426
Mailing Address - Country:US
Mailing Address - Phone:508-954-2472
Mailing Address - Fax:
Practice Address - Street 1:41 TAUNTON GRN STE 204
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3252
Practice Address - Country:US
Practice Address - Phone:508-386-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health