Provider Demographics
NPI:1740816776
Name:LETIZIA, SARA MARIE (MSED, RMHCI)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:LETIZIA
Suffix:
Gender:F
Credentials:MSED, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 S MILITARY TRL APT 1-305
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7606
Mailing Address - Country:US
Mailing Address - Phone:914-268-1616
Mailing Address - Fax:
Practice Address - Street 1:2901 W CYPRESS CREEK RD STE 123
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1732
Practice Address - Country:US
Practice Address - Phone:954-915-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health