Provider Demographics
NPI:1447939210
Name:SULLIVAN, NADINE JOY ULRIKE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:JOY ULRIKE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PACIFIC AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-7407
Mailing Address - Country:US
Mailing Address - Phone:315-778-3705
Mailing Address - Fax:
Practice Address - Street 1:700 PACIFIC AVE APT 107
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-7407
Practice Address - Country:US
Practice Address - Phone:315-778-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker