Provider Demographics
NPI:1689969032
Name:HUCKABEE, SARAH DEAN (MSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DEAN
Last Name:HUCKABEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4803
Mailing Address - Country:US
Mailing Address - Phone:603-621-3697
Mailing Address - Fax:603-622-8101
Practice Address - Street 1:555 AUBURN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-4803
Practice Address - Country:US
Practice Address - Phone:603-621-3697
Practice Address - Fax:603-622-8101
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid