Provider Demographics
NPI:1558842393
Name:BERMINGHAM, SARAH H (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:H
Last Name:BERMINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 BRADLEY ACRES CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3825
Mailing Address - Country:US
Mailing Address - Phone:703-956-6435
Mailing Address - Fax:
Practice Address - Street 1:2751 PROSPERITY AVE STE 150
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4343
Practice Address - Country:US
Practice Address - Phone:703-581-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904010535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker