Provider Demographics
NPI:1659600013
Name:SERISKY, SARA L (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:SERISKY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WASHINGTON ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6024
Mailing Address - Country:US
Mailing Address - Phone:781-249-3905
Mailing Address - Fax:
Practice Address - Street 1:99 WASHINGTON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-6024
Practice Address - Country:US
Practice Address - Phone:781-249-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210454104100000X
MA1161221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker