MEDICARE: SARAH BLECHMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-4792	HI

General Provider Information

NPI Number	:	1588384275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BLECHMAN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 711420
Second Line	:
City	:	MOUNTAIN VIEW
State	:	HI
Zip	:	96771-1420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18-4114 HAUMALU STREET
Second Line	:
City	:	MOUNTAIN VIEW
State	:	HI
Zip	:	96771
Country	:	US
Telephone Number	:	407-733-2763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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