Provider Demographics
NPI:1740676121
Name:SIERRA, SALLY DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:DAWN
Last Name:SIERRA
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 1:1648 LAKE HERON DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-8768
Mailing Address - Country:US
Mailing Address - Phone:787-668-9618
Mailing Address - Fax:
Practice Address - Street 1:517 DELTONA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8016
Practice Address - Country:US
Practice Address - Phone:386-753-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 96481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical