Healthcare Provider Details

I. General information

NPI: 1821427899
Provider Name (Legal Business Name): SARA RUTH MASSEY LISW-S, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA CASERIO

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MILLER RD STE 7
AVON LAKE OH
44012-1013
US

IV. Provider business mailing address

215 MILLER RD STE 7
AVON LAKE OH
44012-1013
US

V. Phone/Fax

Practice location:
  • Phone: 216-712-9992
  • Fax:
Mailing address:
  • Phone: 216-712-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1801248
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1201327
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162077
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: