Provider Demographics
NPI:1225628274
Name:PUSKAVICH, SARAH JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:PUSKAVICH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 STANDISH PL STE 190
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2847
Mailing Address - Country:US
Mailing Address - Phone:202-743-2184
Mailing Address - Fax:
Practice Address - Street 1:7520 STANDISH PL STE 190
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2847
Practice Address - Country:US
Practice Address - Phone:724-288-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional