Provider Demographics
NPI:1568885978
Name:DAVIDSON, SARA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 ADDISON NEW CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-7539
Mailing Address - Country:US
Mailing Address - Phone:413-297-3116
Mailing Address - Fax:
Practice Address - Street 1:1694 PAWNEE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4126
Practice Address - Country:US
Practice Address - Phone:937-372-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1101298104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker