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General NPI Number Information
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NPI Number | 1912096066
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Entity Type | Individual
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Provider Name | SALLY JANE SACKS M.ED LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 319 LITTLETON RD.SUITE 108
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City | WESTFORD
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State | MA
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Zip | 01720-0188
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Country | US
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Telephone | 978-692-6900
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Fax | 978-635-1280
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Provider Business Mailing Address
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Address Line | 5 POWDER HORN LN
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City | ACTON
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State | MA
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Zip | 01720-2013
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Country | US
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Telephone | 978-692-6900
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Fax | 978-635-1280
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 238
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License Number State | MA
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