Provider Demographics
NPI:1053828582
Name:KELLEHER, SARAH A (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W MAIN ST STE 340
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4677
Mailing Address - Country:US
Mailing Address - Phone:919-416-3405
Mailing Address - Fax:919-416-3458
Practice Address - Street 1:2200 W MAIN ST STE 340
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4677
Practice Address - Country:US
Practice Address - Phone:919-416-3405
Practice Address - Fax:919-416-3458
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical