Healthcare Provider Details

I. General information

NPI: 1124352679
Provider Name (Legal Business Name): SARA ELIZABETH WRENN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WHITNEY AVE
HAMDEN CT
06517-2459
US

IV. Provider business mailing address

1400 WHITNEY AVE
HAMDEN CT
06517-2459
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-2116
  • Fax: 203-287-9815
Mailing address:
  • Phone: 203-248-2116
  • Fax: 203-287-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8273
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: