Provider Demographics
NPI:1568502383
Name:WEATHERLEY, SARA - (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:-
Last Name:WEATHERLEY
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 1:4745 MCKINLEY DR.
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-0000
Mailing Address - Country:US
Mailing Address - Phone:720-562-0539
Mailing Address - Fax:
Practice Address - Street 1:400 E SIMPSON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2394
Practice Address - Country:US
Practice Address - Phone:720-562-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical