Provider Demographics
NPI:1639505043
Name:CYNTHIA L SARRIS, PA, LLC
Entity Type:Organization
Organization Name:CYNTHIA L SARRIS, PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-395-9110
Mailing Address - Street 1:46 GRANITE HILL RD
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-2211
Mailing Address - Country:US
Mailing Address - Phone:860-395-9110
Mailing Address - Fax:860-663-2629
Practice Address - Street 1:46 GRANITE HILL RD
Practice Address - Street 2:
Practice Address - City:KILLINGWORTH
Practice Address - State:CT
Practice Address - Zip Code:06419-2211
Practice Address - Country:US
Practice Address - Phone:860-395-9110
Practice Address - Fax:860-663-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTMCD008007950Medicaid