Healthcare Provider Details

I. General information

NPI: 1811965940
Provider Name (Legal Business Name): SARA NAGOT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 STATE ST
MERIDEN CT
06450-3293
US

IV. Provider business mailing address

134 STATE ST
MERIDEN CT
06450-3293
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-2229
  • Fax: 203-686-1677
Mailing address:
  • Phone: 203-237-2229
  • Fax: 203-686-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6420
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: