Provider Demographics
NPI:1649906645
Name:MARTY, SARAH M (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:MARTY
Suffix:
Gender:
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-0378
Mailing Address - Country:US
Mailing Address - Phone:608-515-3327
Mailing Address - Fax:
Practice Address - Street 1:3230 UNIVERSITY AVE STE 6
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3540
Practice Address - Country:US
Practice Address - Phone:608-561-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI110171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11017-123Medicaid