MS. JACQUELYN RUTH SULLIVAN LCSW NPI 1952406282

NPI Information

NPI: 1952406282
Provider Name: MS. JACQUELYN RUTH SULLIVAN, LCSW
Classification: Social Worker - 1041C0700X
Specialization: Clinical
Entity Type: Individual
PECOS Registration: Yes
Address: 76 MAIN STREET
SUITE B
SIDNEY, NY
ZIP 13838
Phone: (607) 563-4080

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NPI Details

MS. Jacquelyn Ruth Sullivan, LCSW is a clinical social worker in Sidney, NY with 24 years of experience. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. MS. Jacquelyn Ruth Sullivan, LCSW NPI is 1952406282. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

76 MAIN STREET
SUITE B
SIDNEY, NY
ZIP 13838
Phone: (607) 563-4080
Fax: (607) 336-7326

The NPI 1952406282 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 9/13/2006 and was last updated on 7/27/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041C0700X	Social Worker	Clinical	071014	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	A300048950	MEDICARE PIN	NEW YORK
2	713668	OTHER	NEW YORK	MVP MOHAWK VALLEY PLAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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