Provider Demographics
NPI:1689101347
Name:ST. GERMAIN, SARAH (LABA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ST. GERMAIN
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SUFFIELD ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2997
Mailing Address - Country:US
Mailing Address - Phone:413-505-0004
Mailing Address - Fax:
Practice Address - Street 1:13 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1860
Practice Address - Country:US
Practice Address - Phone:774-502-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1798103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst