Provider Demographics
NPI:1700467842
Name:ODICIO, SARA ROSE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ROSE
Last Name:ODICIO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 COLONIAL VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6709
Mailing Address - Country:US
Mailing Address - Phone:717-391-0172
Mailing Address - Fax:
Practice Address - Street 1:1808 COLONIAL VILLAGE LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6709
Practice Address - Country:US
Practice Address - Phone:717-391-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1364691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical