Provider Demographics
NPI:1760249189
Name:SAKAGUCHI, YUMI
Entity Type:Individual
Prefix:
First Name:YUMI
Middle Name:
Last Name:SAKAGUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 OSBORNE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1193
Mailing Address - Country:US
Mailing Address - Phone:203-939-5190
Mailing Address - Fax:
Practice Address - Street 1:1445 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1379
Practice Address - Country:US
Practice Address - Phone:203-622-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician