Provider Demographics
NPI:1689756678
Name:LEBOVITZ, SARAH (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LEBOVITZ
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 1:2670 UNION AVENUE EXT STE 710
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4416
Mailing Address - Country:US
Mailing Address - Phone:901-507-6814
Mailing Address - Fax:901-507-6815
Practice Address - Street 1:2670 UNION AVENUE EXT STE 710
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4416
Practice Address - Country:US
Practice Address - Phone:901-507-6814
Practice Address - Fax:901-507-6815
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCSW00000008881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3924350Medicaid
TN4011069OtherBLUE CROSS BLUESHIELD
TN3924350Medicare ID - Type UnspecifiedMEDICARE