Provider Demographics
NPI:1750411443
Name:MESTJIAN, SARA GINNS (LICSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:GINNS
Last Name:MESTJIAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JEAN
Other - Last Name:GINNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12 RAWSTON RD
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4516
Mailing Address - Country:US
Mailing Address - Phone:617-553-0213
Mailing Address - Fax:
Practice Address - Street 1:780 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3908
Practice Address - Country:US
Practice Address - Phone:617-469-8514
Practice Address - Fax:617-325-0353
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical