Provider Demographics
NPI:1659431328
Name:SACHS, NICOLETTE SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:SUZANNE
Last Name:SACHS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 E GREENLAW LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1810
Mailing Address - Country:US
Mailing Address - Phone:928-526-1961
Mailing Address - Fax:928-526-0722
Practice Address - Street 1:2323 E GREENLAW LN
Practice Address - Street 2:SUITE 10
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1810
Practice Address - Country:US
Practice Address - Phone:928-526-1961
Practice Address - Fax:928-526-0722
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW35891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS25759Medicare UPIN