Healthcare Provider Details

I. General information

NPI: 1407750284
Provider Name (Legal Business Name): SAGE PATH MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3528 URBANA PIKE
FREDERICK MD
21704-7742
US

IV. Provider business mailing address

14511 DOWITCHER WAY
BOYDS MD
20841-0167
US

V. Phone/Fax

Practice location:
  • Phone: 301-276-5997
  • Fax:
Mailing address:
  • Phone: 301-276-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: SIERRA LEE
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 301-276-5997