| Provider / Organization | NPI | Date Certified |
|---|---|---|
| EDWARD MARK SULLIVAN | 1659407674 | 2024-04-07 |
Edward Mark Sullivan [M] graduated in 1985 and primarily specializes in Clinical Social Worker.
Edward Mark Sullivan is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1659407674. Registration indicates Edward Mark Sullivan is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Social Worker (Behavioral Health & Social Service Providers, Social Worker) (Social Worker: Clinical, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Social Worker Clinical, Behavioral Health & Social Service Providers) (Social Worker, )
| PECOS ID | 4385874049 |
| Registration | PART-B:Y DME:Y HHA:N PMD:N |
| Entity Type | Individual |
| Provider Name | Edward Mark Sullivan MSW, LISW-S |
| Practice Office Address | 570 N STATE ST STE 220C WESTERVILLE, OH US |
| Practice Office Telephone | 6146968400 |
| Practice Office Fax | 6143629909 |
| Mailing Address | 497 SIOUX DR WESTERVILLE, OH 430812624 US |
| Business Telephone | 6143185289 |
| Business Fax | 6143043099 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 6000 Cooper Rd | Westerville, OH 430818984 | 6146968400 / 6143629909 |
| Code | Practice | License No State |
|---|---|---|
| 1041C0700X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Social Worker Behavioral Health & Social Service Providers Social Worker Social Worker: Clinical Behavioral Health/Substance Abuse/Psychiatry Social Worker Clinical Behavioral Health & Social Service Providers Social Worker | I0004577
OH |
| 193400000X SING | Group Code |
| 0243763 | MEDICAID | OH | |
| PO1698877 | OTHER | OH | MEDICARE |