Provider Demographics
NPI:1619434123
Name:ABBATIELLO, SARA ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:ELIZABETH
Last Name:ABBATIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1838
Mailing Address - Country:US
Mailing Address - Phone:908-268-7923
Mailing Address - Fax:
Practice Address - Street 1:520 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7420
Practice Address - Country:US
Practice Address - Phone:732-600-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06258900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker