Provider Demographics
NPI:1598748154
Name:SAGE, LAURA VAIL (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:VAIL
Last Name:SAGE
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3962 MIAMI RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3349
Mailing Address - Country:US
Mailing Address - Phone:513-271-0340
Mailing Address - Fax:513-271-0340
Practice Address - Street 1:5134 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3717
Practice Address - Country:US
Practice Address - Phone:513-229-7900
Practice Address - Fax:513-229-0202
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH944032101YA0400X
OHI 00054421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSASW25352Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID NU