Provider Demographics
NPI:1760713093
Name:BERRY, SARA E (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:BERRY
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 1:824 ROOSEVELT TRL # 280
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5370
Mailing Address - Country:US
Mailing Address - Phone:207-332-8870
Mailing Address - Fax:
Practice Address - Street 1:824 ROOSEVELT TRL # 280
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5370
Practice Address - Country:US
Practice Address - Phone:207-332-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC153561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical