Healthcare Provider Details

I. General information

NPI: 1245654904
Provider Name (Legal Business Name): SARA KAITLIN JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 BYBERRY RD STE 108
HATBORO PA
19040-2831
US

IV. Provider business mailing address

196 N HIGHLAND AVE
NORRISTOWN PA
19403-2974
US

V. Phone/Fax

Practice location:
  • Phone: 215-957-9771
  • Fax:
Mailing address:
  • Phone: 860-965-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCW020548
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: