Healthcare Provider Details

I. General information

NPI: 1285884205
Provider Name (Legal Business Name): INGRID SARMIENTO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 PLANTATION ST
WORCESTER MA
01604-3069
US

IV. Provider business mailing address

23 CRESTVIEW RD
LITTLETON MA
01460-2106
US

V. Phone/Fax

Practice location:
  • Phone: 508-849-5600
  • Fax:
Mailing address:
  • Phone: 617-699-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11843
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: