Provider Demographics
NPI:1619420304
Name:EDMOND, SARA N (PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:N
Last Name:EDMOND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:N
Other - Last Name:RED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 CAMPBELL AVE # 116B
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2770
Mailing Address - Country:US
Mailing Address - Phone:443-812-1835
Mailing Address - Fax:
Practice Address - Street 1:950 CAMPBELL AVE # 116B
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:443-812-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical