Provider Demographics
NPI:1639109788
Name:LUSK, SARAH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:L
Last Name:LUSK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4861
Mailing Address - Country:US
Mailing Address - Phone:617-999-8078
Mailing Address - Fax:888-382-5041
Practice Address - Street 1:20 WILLARD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4861
Practice Address - Country:US
Practice Address - Phone:617-999-8078
Practice Address - Fax:888-382-5041
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6404103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05389Medicare UPIN