Provider Demographics
NPI:1952522484
Name:LOOMIS, SABRINA CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:CAROL
Last Name:LOOMIS
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 1:700 RAY O VAC DR
Mailing Address - Street 2:STE 220
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2476
Mailing Address - Country:US
Mailing Address - Phone:608-257-2880
Mailing Address - Fax:
Practice Address - Street 1:5 ODANA COURT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-444-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7263-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43595300Medicaid