Provider Demographics
NPI:1902581234
Name:SULLIVAN, EMILY JUSTINE (MSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JUSTINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E KNOLL
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2829 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567-5545
Practice Address - Country:US
Practice Address - Phone:518-398-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker