Provider Demographics
NPI:1184950941
Name:SULLIVAN, SARA (MA, LCMHC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03821-2063
Mailing Address - Country:US
Mailing Address - Phone:617-302-6278
Mailing Address - Fax:617-302-6278
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3744
Practice Address - Country:US
Practice Address - Phone:617-302-6278
Practice Address - Fax:617-302-6278
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99003227Medicaid
NH99003227Medicaid