Provider Demographics
NPI:1336865443
Name:ELLSWORTH, SABRINA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:ELLSWORTH
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:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-0251
Mailing Address - Country:US
Mailing Address - Phone:435-619-1220
Mailing Address - Fax:
Practice Address - Street 1:11479 E 15900 N
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-5687
Practice Address - Country:US
Practice Address - Phone:435-619-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12707489-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical