1467991711 NPI number — SARA JASTRZEBSKI MA, LCMHC, CCTP, NCC

Table of content: SARA JASTRZEBSKI MA, LCMHC, CCTP, NCC (NPI 1467991711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467991711 NPI number — SARA JASTRZEBSKI MA, LCMHC, CCTP, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JASTRZEBSKI
Provider First Name:
SARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LCMHC, CCTP, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467991711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91 RESERVE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-7922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-836-5845
Provider Business Mailing Address Fax Number:
603-600-7800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1037-1045 ELM STREET
Provider Second Line Business Practice Location Address:
2ND, 3RD, 5TH & 6TH FLOORS
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-226-3514
Provider Business Practice Location Address Fax Number:
603-600-7800
Provider Enumeration Date:
02/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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