Healthcare Provider Details

I. General information

NPI: 1366530149
Provider Name (Legal Business Name): LATASHA KALEEMEA SARPY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EASTBROOK RD STE 101
DEDHAM MA
02026-2083
US

IV. Provider business mailing address

30 EASTBROOK RD STE 101
DEDHAM MA
02026-2083
US

V. Phone/Fax

Practice location:
  • Phone: 857-293-5020
  • Fax: 857-226-8772
Mailing address:
  • Phone: 857-293-5020
  • Fax: 857-226-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13408
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122392
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW03274
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: