Provider Demographics
NPI:1528408143
Name:LAND, SARA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:E
Last Name:LAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:235 FAYETTE ST
Mailing Address - Street 2:APT. #1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1628
Mailing Address - Country:US
Mailing Address - Phone:414-336-4369
Mailing Address - Fax:617-855-3730
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:EAST HOUSE 3, MAIL STOP 130
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1064
Practice Address - Country:US
Practice Address - Phone:617-855-2806
Practice Address - Fax:617-855-3730
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical