Provider Demographics
NPI:1255031431
Name:ETTI, SARAH V
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:V
Last Name:ETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 W SPRUCE ST # 1287
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2553
Mailing Address - Country:US
Mailing Address - Phone:813-419-0073
Mailing Address - Fax:
Practice Address - Street 1:1211 TECH BLVD
Practice Address - Street 2:STE 145
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2553
Practice Address - Country:US
Practice Address - Phone:813-419-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW191711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical