Provider Demographics
NPI:1255641072
Name:SULLIVAN, REBECHA KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECHA
Middle Name:KAY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECHA
Other - Middle Name:K
Other - Last Name:STOCKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 TIMBERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-915-7688
Mailing Address - Fax:
Practice Address - Street 1:35 TIMBERLAND WAY
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-915-7688
Practice Address - Fax:203-924-2334
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical