Provider Demographics
NPI:1740796960
Name:GOSSLER, SARAH JEWETT (LICSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEWETT
Last Name:GOSSLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 GROSVENOR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3617
Mailing Address - Country:US
Mailing Address - Phone:401-435-7828
Mailing Address - Fax:
Practice Address - Street 1:261 GROSVENOR AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3617
Practice Address - Country:US
Practice Address - Phone:401-435-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102902104100000X
RIISW001201041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker