Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary A Sullivan, PCNS

Individual provider Mental Health Counselor · NPI 1386662484

Mary A Sullivan, PCNS is a Nurse Practitioner in Providence, Rhode Island. Qualified in 2005, 21 years ago. Accepts Medicare assignment and offers telehealth. Licensed in California and Rhode Island.

Years since qualifying
21
Licensed in
CA, RI
In the registry since
2006
Specialties on file
2
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Practice location Address checks out

50 Maude St
Providence, RI 02908-4325
Phone: (401) 456-2000
Fax: (401) 456-6554
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 21544 (CA)
Mental Health Counselor Taxonomy 101YM0800X · Licence PPNS00073 (RI)

Record details

NPI number1386662484
Entity typeIndividual (Type 1)
GenderFemale
Credentials PCNS
Sole proprietorNo
NPI enumeratedJuly 17, 2006
Last updated in NPPESFebruary 2, 2012
Mailing address50 Maude St, Providence, RI 02908-4325

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Providence