Provider Demographics
NPI:1518748508
Name:KETTLER, SARA (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KETTLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:KETTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:104 LADYSHIRE LN APT C401
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6483
Mailing Address - Country:US
Mailing Address - Phone:301-379-2694
Mailing Address - Fax:
Practice Address - Street 1:4915 SAINT ELMO AVE # 504
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6019
Practice Address - Country:US
Practice Address - Phone:301-229-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD292711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical