Provider Demographics
NPI:1467524314
Name:EICHSTAEDT, SARA HALINE (LICSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HALINE
Last Name:EICHSTAEDT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BOND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3401
Mailing Address - Country:US
Mailing Address - Phone:413-731-6052
Mailing Address - Fax:
Practice Address - Street 1:25 BOND ST
Practice Address - Street 2:SPRINGFIELD VA OUTPATIENT CLINIC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-731-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical