Provider Demographics
NPI:1992859037
Name:LARACUENTE, SABASKA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SABASKA
Middle Name:MARIE
Last Name:LARACUENTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 QUEENSBERRY ST
Mailing Address - Street 2:APT. A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5033
Mailing Address - Country:US
Mailing Address - Phone:617-670-1280
Mailing Address - Fax:617-983-6069
Practice Address - Street 1:3297 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2655
Practice Address - Country:US
Practice Address - Phone:617-983-6032
Practice Address - Fax:617-983-6069
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4920101YM0800X
MA8123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51407Medicare ID - Type Unspecified