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General NPI Number Information
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NPI Number | 1336263367
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Entity Type | Individual
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Provider Name | SARA FAYE SACKVILLE LCSW-C, LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 5411 W CEDAR LN
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City | BETHESDA
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State | MD
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Zip | 20814-1516
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Country | US
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Telephone | 301-514-4978
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Fax | 301-514-4978
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Provider Business Mailing Address
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Address Line | 7300 FLOWER AVE APT 4
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City | TAKOMA PARK
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State | MD
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Zip | 20912-6431
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Country | US
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Telephone | 301-514-4978
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Fax | 301-514-4978
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14328
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079144
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License Number State | DC
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