Provider Demographics
NPI:1962762625
Name:SULKALA, AMY LOUISE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:SULKALA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SHAWMUT AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2243
Mailing Address - Country:US
Mailing Address - Phone:508-641-2157
Mailing Address - Fax:
Practice Address - Street 1:275 PROSPECT ST
Practice Address - Street 2:THE PHOENIX SCHOOL
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-1467
Practice Address - Country:US
Practice Address - Phone:781-551-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107491041C0700X
MA4055721041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool