Provider Demographics
NPI:1821427899
Name:CASERIO, SARA RUTH (LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RUTH
Last Name:CASERIO
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MILLER RD STE 7
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1013
Mailing Address - Country:US
Mailing Address - Phone:216-712-9992
Mailing Address - Fax:
Practice Address - Street 1:215 MILLER RD STE 7
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1013
Practice Address - Country:US
Practice Address - Phone:216-712-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1201327104100000X
390200000X
OHI.18012481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program