Provider Demographics
NPI:1568912467
Name:SARAH EKNAIAN
Entity Type:Organization
Organization Name:SARAH EKNAIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JAIL DIVERSION CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EKNAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-600-1312
Mailing Address - Street 1:552 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2224
Mailing Address - Country:US
Mailing Address - Phone:617-600-1312
Mailing Address - Fax:617-600-1384
Practice Address - Street 1:552 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2224
Practice Address - Country:US
Practice Address - Phone:617-600-1312
Practice Address - Fax:617-600-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========Medicaid