Provider Demographics
NPI:1457443392
Name:PARDEE, SARA HAYES (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HAYES
Last Name:PARDEE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-490-5121
Mailing Address - Fax:401-490-2113
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-490-5121
Practice Address - Fax:401-490-2113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW00749104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI234182000Medicare UPIN
RI23718-7Medicare UPIN
RI005124Medicare UPIN
RI60054Medicare UPIN
RIA018493Medicare UPIN
RI62-78432Medicare UPIN
RI809023718Medicare ID - Type UnspecifiedMEDICARE