Basic Information
| Provider Information | |||||||||
| NPI: | 1295299097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | HANNAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1018 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047361018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074986431 | ||||||||
| FaxNumber: | 2074923181 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 STEVES LN | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046545045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072550996 | ||||||||
| FaxNumber: | 2072558748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2019 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.