Provider Demographics
NPI:1376201277
Name:GREEN, SARA RUTH (PHD, MSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RUTH
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1508
Mailing Address - Country:US
Mailing Address - Phone:805-341-1355
Mailing Address - Fax:
Practice Address - Street 1:127 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2651
Practice Address - Country:US
Practice Address - Phone:484-887-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138091104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker