Provider Demographics
NPI:1407103104
Name:SAKS, LORETTA VITALE (MSW)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:VITALE
Last Name:SAKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:LORETTA
Other - Middle Name:V
Other - Last Name:SAKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:4307 CLAGETT RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1140
Mailing Address - Country:US
Mailing Address - Phone:301-529-4241
Mailing Address - Fax:
Practice Address - Street 1:4307 CLAGETT RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:MD
Practice Address - Zip Code:20782-1140
Practice Address - Country:US
Practice Address - Phone:301-529-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD071001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07100OtherLCSW-C