Healthcare Provider Details

I. General information

NPI: 1346089786
Provider Name (Legal Business Name): SARAH ST.MARTIN CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 E WINCHESTER ST STE 110
MURRAY UT
84107-8538
US

IV. Provider business mailing address

1773 E HUBBARD AVE
SALT LAKE CITY UT
84108-1339
US

V. Phone/Fax

Practice location:
  • Phone: 801-796-2713
  • Fax:
Mailing address:
  • Phone: 914-646-2684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13994063-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: