Healthcare Provider Details

I. General information

NPI: 1447663760
Provider Name (Legal Business Name): MS. SARA NICOLE LALIBERTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PARK AVE
WORCESTER MA
01603
US

IV. Provider business mailing address

14 SASSAWANNA RD
RUTLAND MA
01543-1417
US

V. Phone/Fax

Practice location:
  • Phone: 774-823-1500
  • Fax:
Mailing address:
  • Phone: 774-345-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1120119
License Number StateMA

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: