=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114838893
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH JEAN WOODWORTH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2026
-----------------------------------------------------
Last Update Date | 09/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4830 LOOMIS RD
-----------------------------------------------------
City | RUSHVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14544-9645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-967-3693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4830 LOOMIS RD
-----------------------------------------------------
City | RUSHVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14544-9645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-967-3693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 093627
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------