Provider Demographics
NPI:1891307682
Name:JAMISON, SARA EVE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:EVE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FIELDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2581
Mailing Address - Country:US
Mailing Address - Phone:203-912-9978
Mailing Address - Fax:
Practice Address - Street 1:129 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2581
Practice Address - Country:US
Practice Address - Phone:203-912-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health