Healthcare Provider Details

I. General information

NPI: 1679169106
Provider Name (Legal Business Name): SARAH ANN CUCCHIARA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SMART ST
WALTHAM MA
02451-2158
US

IV. Provider business mailing address

40 SMART ST
WALTHAM MA
02451-2158
US

V. Phone/Fax

Practice location:
  • Phone: 781-775-3710
  • Fax:
Mailing address:
  • Phone: 781-775-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number224143
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: