Healthcare Provider Details

I. General information

NPI: 1538603212
Provider Name (Legal Business Name): SARAH MILDRUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 06/06/2022
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TANDBERG TRL
WINDHAM ME
04062-5206
US

IV. Provider business mailing address

PO BOX 32
RAYMOND ME
04071-0032
US

V. Phone/Fax

Practice location:
  • Phone: 207-653-9349
  • Fax:
Mailing address:
  • Phone: 207-318-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC15886
License Number StateME

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: