Provider Demographics
NPI:1982342218
Name:WATTENBERG, SARAH ANITA (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ANITA
Last Name:WATTENBERG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ANITA
Other - Last Name:WATTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4104 MITSCHER CT
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1307
Mailing Address - Country:US
Mailing Address - Phone:240-460-7604
Mailing Address - Fax:
Practice Address - Street 1:4104 MITSCHER CT
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1307
Practice Address - Country:US
Practice Address - Phone:240-460-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD071011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical