Provider Demographics
NPI:1346751385
Name:SORTINO, SARAH REBECCA
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:REBECCA
Last Name:SORTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LENNOX AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3123
Mailing Address - Country:US
Mailing Address - Phone:860-906-8259
Mailing Address - Fax:
Practice Address - Street 1:163 LEAD MINE BROOK RD
Practice Address - Street 2:
Practice Address - City:HARWINTON
Practice Address - State:CT
Practice Address - Zip Code:06791-1315
Practice Address - Country:US
Practice Address - Phone:860-338-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician