Provider Demographics
NPI:1073801643
Name:WALTER, SARAH CALLICUTT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CALLICUTT
Last Name:WALTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:LYN
Other - Last Name:CALLICUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 VICTOR RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4234
Mailing Address - Country:US
Mailing Address - Phone:678-773-6353
Mailing Address - Fax:
Practice Address - Street 1:94 AUBURN ST STE 209
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2100
Practice Address - Country:US
Practice Address - Phone:678-773-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 1041C0700X
MELC177341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator