Provider Demographics
NPI:1053458869
Name:MIELKE, SARAH ELLEN (LICSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELLEN
Last Name:MIELKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 OLD HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1800
Mailing Address - Country:US
Mailing Address - Phone:978-266-1130
Mailing Address - Fax:
Practice Address - Street 1:100 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1804
Practice Address - Country:US
Practice Address - Phone:978-840-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10175711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical