Provider Demographics
NPI:1760807754
Name:HELLER, SARA (LPC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:CT
Mailing Address - Zip Code:06058-1327
Mailing Address - Country:US
Mailing Address - Phone:860-542-7128
Mailing Address - Fax:
Practice Address - Street 1:39 GRANT ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:CT
Practice Address - Zip Code:06058-1327
Practice Address - Country:US
Practice Address - Phone:860-542-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2656101YP2500X
RIMHC00608101YM0800X
CT1108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health