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NPI Code Detail

MEDICARE: SAGE PSYCHOTHERAPY LLC

MEDICARE: SAGE PSYCHOTHERAPY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker008404CT

General Provider Information

NPI Number : 1568915684
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAGE PSYCHOTHERAPY LLC
Provider Business Mailing Address
First Line : 155 SIDNEY AVE
Second Line :
City : WEST HARTFORD
State : CT
Zip : 06110-1030
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 298 PARK RD
Second Line : SUITE 3
City : WEST HARTFORD
State : CT
Zip : 06119-2018
Country : US
Telephone Number : 860-212-7066
Fax Number :
Authorized Official
Title or Position : PSYCHOTHERAPIST
Name : ANNE E KEATING-SCHERER
Credential : LCSW
Telephone Number : 860-212-7066
Provider Enumeration Date : 07/25/2016
Last Update Date : 07/25/2016

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