Provider Demographics
NPI:1972702801
Name:MORT, SARAH (LI CSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MORT
Suffix:
Gender:F
Credentials:LI CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 PURGATORY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5963
Mailing Address - Country:US
Mailing Address - Phone:401-374-4764
Mailing Address - Fax:401-846-9868
Practice Address - Street 1:37 POWEL AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2693
Practice Address - Country:US
Practice Address - Phone:401-374-1598
Practice Address - Fax:401-846-9868
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI021061041C0700X
NY073471-11041C0700X
TN50941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical