Individual provider · Type 1 NPI

Mackenna Delores Sullivan, LGSW

Clinical Social Worker · Edina, MN

NPI number 1053237339 Active

Practice location

4820 77th St W Ste 130
Edina, MN 55435-4832

Specialties and licenses

Taxonomy	Code	License
Clinical Social Worker Primary	1041C0700X	29680 (MN)

Clinical Social Worker: 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 interpers…

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About NPI 1053237339

Mackenna Delores Sullivan, LGSW's National Provider Identifier is 1053237339, issued on Jun 29, 2026. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Edina, MN. The record was last updated on Jun 29, 2026.