Provider Demographics
NPI:1831283308
Name:FILLIETTAZ, SARA D (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:D
Last Name:FILLIETTAZ
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 1:95 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4033
Mailing Address - Country:US
Mailing Address - Phone:978-225-2250
Mailing Address - Fax:978-225-2251
Practice Address - Street 1:57 PORTLAND RD
Practice Address - Street 2:UNIT #7
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6661
Practice Address - Country:US
Practice Address - Phone:207-632-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC8788104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1524Medicare ID - Type Unspecified