Healthcare Provider Details

I. General information

NPI: 1427297282
Provider Name (Legal Business Name): SARAH PORELL LICSW, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 LANDSEER ST
WEST ROXBURY MA
02132-3436
US

IV. Provider business mailing address

63 LANDSEER ST
WEST ROXBURY MA
02132-3436
US

V. Phone/Fax

Practice location:
  • Phone: 617-515-4172
  • Fax:
Mailing address:
  • Phone: 617-515-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114206
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: