Provider Demographics
NPI:1144468570
Name:SULLIVAN, JONELLE DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:JONELLE
Middle Name:DENISE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PHOENIX AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4931
Mailing Address - Country:US
Mailing Address - Phone:978-513-2387
Mailing Address - Fax:
Practice Address - Street 1:126 PHOENIX AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4931
Practice Address - Country:US
Practice Address - Phone:978-513-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2151261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical