Healthcare Provider Details

I. General information

NPI: 1063233542
Provider Name (Legal Business Name): SARA BURNETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 ARGALI DR
SEVERANCE CO
80550-2896
US

IV. Provider business mailing address

1205 ARGALI DR
SEVERANCE CO
80550-2896
US

V. Phone/Fax

Practice location:
  • Phone: 630-699-6544
  • Fax:
Mailing address:
  • Phone: 630-699-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09929691
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: