Provider Demographics
NPI:1851553069
Name:BOOTH, SARA M (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:M
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 E FIRELANDS DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2450
Mailing Address - Country:US
Mailing Address - Phone:216-269-2978
Mailing Address - Fax:
Practice Address - Street 1:4979 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2601
Practice Address - Country:US
Practice Address - Phone:216-839-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700284-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker