Healthcare Provider Details

I. General information

NPI: 1144085945
Provider Name (Legal Business Name): IVANE SINAI SAENZ LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MALLOY ST STE B
GOLDSBORO NC
27534-4478
US

IV. Provider business mailing address

208 MALLOY ST STE B
GOLDSBORO NC
27534-4478
US

V. Phone/Fax

Practice location:
  • Phone: 984-520-6080
  • Fax:
Mailing address:
  • Phone: 984-520-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020191
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: