MEDICARE: MISS SARAH MACHOLD 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	1041S0200X	School Social Worker	PPS-0604582	VA
2	1041C0700X	Clinical Social Worker	0904013099	VA

General Provider Information

NPI Number	:	1982375754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SARAH MACHOLD LCSW

Provider Business Mailing Address
First Line	:	6107 HORSE FARM LN
Second Line	:
City	:	PORT REPUBLIC
State	:	VA
Zip	:	24471-2634
Country	:	US
Telephone Number	:	540-466-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 HORSE FARM LN
Second Line	:
City	:	PORT REPUBLIC
State	:	VA
Zip	:	24471-2634
Country	:	US
Telephone Number	:	540-607-6910
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/23/2021

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Directions to “ MISS SARAH MACHOLD LCSW” Practice Location

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