Provider Demographics
NPI:1265611826
Name:HERNANDEZ, SARA (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1814
Mailing Address - Country:US
Mailing Address - Phone:203-488-9637
Mailing Address - Fax:
Practice Address - Street 1:303 CHURCH ST STE 1
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2468
Practice Address - Country:US
Practice Address - Phone:203-654-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0030561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical