Provider Demographics
NPI:1306832324
Name:SARI, COLLEEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:E
Last Name:SARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:E
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 SHAWME RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563
Mailing Address - Country:US
Mailing Address - Phone:412-512-0822
Mailing Address - Fax:
Practice Address - Street 1:LATHAM CENTERS 1646 MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631
Practice Address - Country:US
Practice Address - Phone:508-237-2110
Practice Address - Fax:508-896-6782
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058183L2084P0800X, 2084P0804X
MA2794222084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000858344OtherHIGHMARK
PA0015383829Medicaid
PA0015383829Medicaid
OH0054862Medicaid
NJ0328073Medicaid