Healthcare Provider Details

I. General information

NPI: 1184533267
Provider Name (Legal Business Name): SARA HAFEZ BASYOUNY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WEST ST STE 3D
CROMWELL CT
06416-4400
US

IV. Provider business mailing address

96 FLANDERS RIVER RD
COVENTRY CT
06238-3413
US

V. Phone/Fax

Practice location:
  • Phone: 860-893-5628
  • Fax:
Mailing address:
  • Phone: 203-928-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12516
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: