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JESSICA C SULLIVAN LCSW-R
NPI 1396085304
Social Worker - Clinical in Monroe, NY

Active since February 28, 2013Opted out of Medicare · through Jun 28, 2027
360 STATE ROUTE 17M, SUITE 4, MONROE, NY 10950(845) 547-0479(845) 547-0479 Get Directions Write a Review

NPPES record last updated: June 24, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 24, 2020, Jun 23, 2017 (2 updates tracked since 2017).

About Jessica C Sullivan Lcsw-r NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA C SULLIVAN LCSW-R (NPI 1396085304) is an individual clinical provider in Monroe, New York, licensed in New York (R085591) and active in the NPI registry since February 2013. She has opted out of Medicare through June 28, 2027.

NPPES Registry Identity

NPI1396085304
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameJESSICA C SULLIVANCredential: LCSW-R
Location Address360 STATE ROUTE 17M, SUITE 4Monroe, NY 10950-3443
Mailing Address360 State Route 17m, Suite 4Monroe, NY 10950-3443 · (845) 547-0479 · Fax (845) 547-0479
Phone(845) 547-0479
Fax(845) 547-0479
Sole ProprietorNo
Enumeration DateFebruary 28, 2013
Last NPPES UpdateJune 24, 20202 updates tracked since enumeration
NPPES CertifiedJune 24, 2020
✔ NPI 1396085304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in NY · R085591
Definition
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.
360 STATE ROUTE 17M, Monroe, NY 10950
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jessica C Sullivan Lcsw-r has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 28, 2023 through June 28, 2027.

Opt-Out Effective DateJune 28, 2023
Opt-Out In Effect ThroughJune 28, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRIANNA PINE EDWARDS LCSW
Social Worker (Clinical)
360 STATE ROUTE 17M
MONROE, NY 10950
Orange County (909) 713-8733
ASHLEY VELAZQUEZ
Counselor (Mental Health)
360 STATE ROUTE 17M
MONROE, NY 10950
Orange County (845) 547-0479
LARA DEMBERG VOLOTO LMHC
Counselor
360 STATE ROUTE 17M
MONROE, NY 10950
Orange County (914) 588-8166
ALYSSA M GAU LMHC
Counselor (Mental Health)
360 STATE ROUTE 17M
MONROE, NY 10950
Orange County (845) 547-0479

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Sullivan's NPI number?

The NPI number for Jessica Sullivan is 1396085304. It was assigned to this individual provider in the NPPES registry on February 28, 2013.

Where is Jessica Sullivan located?

Jessica Sullivan practices at 360 State Route 17M Suite 4, Monroe, NY 10950. The listed phone number is (845) 547-0479.

What is Jessica Sullivan's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jessica Sullivan enrolled in Medicare?

No. Jessica Sullivan has opted out of Medicare through June 28, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jessica Sullivan was last updated on June 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.