Healthcare Provider Details

I. General information

NPI: 1851998819
Provider Name (Legal Business Name): SARAH MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HOSPITAL AVE
DANBURY CT
06810-9001
US

IV. Provider business mailing address

619 DANBURY RD UNIT 300
RIDGEFIELD CT
06877-2756
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-0400
  • Fax:
Mailing address:
  • Phone: 203-953-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number010753
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: