Provider Demographics
NPI:1750158101
Name:WISE, SARAH E (LMSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:WISE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 BOSTON ST STE 421
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5281
Mailing Address - Country:US
Mailing Address - Phone:410-907-7656
Mailing Address - Fax:410-457-3205
Practice Address - Street 1:3500 BOSTON ST STE 421
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5281
Practice Address - Country:US
Practice Address - Phone:410-907-7656
Practice Address - Fax:410-457-3205
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24690104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker