Provider Demographics
NPI:1679819718
Name:MOYER, SARA NICOLE (LSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:NICOLE
Last Name:MOYER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-4714
Mailing Address - Country:US
Mailing Address - Phone:330-445-1042
Mailing Address - Fax:330-437-3763
Practice Address - Street 1:408 9TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-4714
Practice Address - Country:US
Practice Address - Phone:330-445-1042
Practice Address - Fax:330-437-3763
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 1200087104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker