Provider Demographics
NPI:1548610827
Name:ARDITO, SARAH ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:ARDITO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:R
Other - Last Name:MORTALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 7720
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-0720
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:
Practice Address - Street 1:400 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:035-033-0552
Practice Address - Fax:203-503-3466
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT102941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008081953Medicaid