Provider Demographics
NPI:1578231957
Name:LANDRY, SARAH REBECCA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:LANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:REBECCA
Other - Last Name:JORGENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9701 FIELDS RD APT 1600
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2732
Mailing Address - Country:US
Mailing Address - Phone:240-731-9852
Mailing Address - Fax:
Practice Address - Street 1:9701 FIELDS RD APT 1600
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2732
Practice Address - Country:US
Practice Address - Phone:240-731-9852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor