Provider Demographics
NPI:1669093456
Name:SULLIVAN, ASHLEY (BS)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 OLD SCHOOLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1345
Mailing Address - Country:US
Mailing Address - Phone:781-724-9816
Mailing Address - Fax:
Practice Address - Street 1:460 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8130
Practice Address - Country:US
Practice Address - Phone:617-847-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health