Provider Demographics
NPI:1407590342
Name:POULIN, SARAH MEAGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MEAGAN
Last Name:POULIN
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 1:144 BLOCK ST
Mailing Address - Street 2:
Mailing Address - City:BLOSSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16912-9787
Mailing Address - Country:US
Mailing Address - Phone:570-404-5276
Mailing Address - Fax:
Practice Address - Street 1:144 BLOCK ST
Practice Address - Street 2:
Practice Address - City:BLOSSBURG
Practice Address - State:PA
Practice Address - Zip Code:16912-9787
Practice Address - Country:US
Practice Address - Phone:570-404-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0199961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical