Provider Demographics
NPI:1003533415
Name:SAGOE, HENRIETTA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:
Last Name:SAGOE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13017 WISTERIA DR STE 114
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2621
Mailing Address - Country:US
Mailing Address - Phone:301-812-4540
Mailing Address - Fax:301-238-7850
Practice Address - Street 1:12800 MIDDLEBROOK RD STE 400
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5282
Practice Address - Country:US
Practice Address - Phone:301-515-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182948363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health