Provider Demographics
NPI:1073665592
Name:WAITE, SARAH HOLLOWAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:HOLLOWAY
Last Name:WAITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:WAITE
Other - Last Name:CORUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 WELLSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2771
Mailing Address - Country:US
Mailing Address - Phone:207-879-4083
Mailing Address - Fax:
Practice Address - Street 1:215 CONGRESS STREET
Practice Address - Street 2:PROP EAST END CHILDRENS WORKSHOP
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3621
Practice Address - Country:US
Practice Address - Phone:207-772-5467
Practice Address - Fax:207-780-9823
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC24471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical