Provider Demographics
NPI:1386224491
Name:KOUTEN, SARA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:KOUTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N PONCE DE LEON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1400
Mailing Address - Country:US
Mailing Address - Phone:904-822-4347
Mailing Address - Fax:904-372-6153
Practice Address - Street 1:188 PINE ARBOR CIR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6522
Practice Address - Country:US
Practice Address - Phone:904-822-4347
Practice Address - Fax:904-372-6153
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW185511041C0700X
NJ445C059667001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical