Provider Demographics
NPI:1598248569
Name:MCNAMARA, SASHA LOUISE (LICSW)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:LOUISE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3777
Mailing Address - Country:US
Mailing Address - Phone:774-238-2429
Mailing Address - Fax:
Practice Address - Street 1:100 W MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3777
Practice Address - Country:US
Practice Address - Phone:774-238-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1115311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical