Provider Demographics
NPI:1619759917
Name:SAMEDI, SARA BLYTHE (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BLYTHE
Last Name:SAMEDI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BLYTHE
Other - Last Name:EVJEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4924
Mailing Address - Country:US
Mailing Address - Phone:503-860-1040
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4140
Practice Address - Country:US
Practice Address - Phone:443-846-0404
Practice Address - Fax:443-860-6767
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28231104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker