Provider Demographics
NPI:1649761222
Name:MALTESE, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MALTESE
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 1:81 BROOKFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4214
Mailing Address - Country:US
Mailing Address - Phone:860-933-5751
Mailing Address - Fax:888-257-1805
Practice Address - Street 1:81 BROOKFIELD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4214
Practice Address - Country:US
Practice Address - Phone:860-933-5751
Practice Address - Fax:888-257-1805
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst