Provider Demographics
NPI:1912096066
Name:SACKS, SALLY JANE (MED LMHC)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:JANE
Last Name:SACKS
Suffix:
Gender:F
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5 POWDER HORN LN
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2013
Mailing Address - Country:US
Mailing Address - Phone:978-692-6900
Mailing Address - Fax:978-635-1280
Practice Address - Street 1:319 LITTLETON RD.SUITE 108
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01720-0188
Practice Address - Country:US
Practice Address - Phone:978-692-6900
Practice Address - Fax:978-635-1280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health