Mrs Antoinette O Sullivan, LICSW | |
65 Village Square Dr, South Kingstown, RI 02879-2292 | |
(401) 789-5924 | |
(401) 782-1770 |
Full Name | Mrs Antoinette O Sullivan |
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Gender | Female |
Speciality | Social Worker - Clinical |
Location | 65 Village Square Dr, South Kingstown, Rhode Island |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1366582819 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | ISW01516 (Rhode Island) | Primary |
Entity Name | Coastal Medical Physicians Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1780273540 PECOS PAC ID: 0345658316 Enrollment ID: O20210427001413 |
Mailing Address | Practice Location Address |
---|---|
Mrs Antoinette O Sullivan, LICSW 10 Davol Sq, Suite 400, Providence, RI 02903-4754 Ph: (401) 421-4000 | Mrs Antoinette O Sullivan, LICSW 65 Village Square Dr, South Kingstown, RI 02879-2292 Ph: (401) 789-5924 |
Deborah M Roberts, LICSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 65 Village Square Dr Ste 302, South Kingstown, RI 02879 Phone: 401-785-0400 | |
Nancy H. Embleton, LICSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 65 Village Square Dr Ste 302, South Kingstown, RI 02879 Phone: 401-785-0040 | |
Ashley Daigneault, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 65 Village Square Dr Ste 302, South Kingstown, RI 02879 Phone: 401-785-0040 | |
Aaron Pelchat, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 65 Village Square Dr Ste 302, South Kingstown, RI 02879 Phone: 401-785-6175 Fax: 401-633-6253 |