Provider Demographics
NPI:1962410035
Name:SABO, CATHY LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:LYNN
Last Name:SABO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:CATHY
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:12850 FOUNTAIN SQ
Mailing Address - Street 2:STE. 106
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12850 FOUNTAIN SQ
Practice Address - Street 2:STE. 106
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-2552
Practice Address - Country:US
Practice Address - Phone:248-634-6303
Practice Address - Fax:248-634-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68010768781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP28210Medicare ID - Type Unspecified