Healthcare Provider Details

I. General information

NPI: 1023053410
Provider Name (Legal Business Name): SARA WYE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 E GREENWICH AVE
WEST WARWICK RI
02893-5413
US

IV. Provider business mailing address

129 E GREENWICH AVE
WEST WARWICK RI
02893-5413
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-0929
  • Fax: 401-821-0929
Mailing address:
  • Phone: 401-821-0929
  • Fax: 401-821-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00040
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: