Provider Demographics
NPI:1063250751
Name:NEGUSSIE, SARA A (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:A
Last Name:NEGUSSIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 MCCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7200
Mailing Address - Country:US
Mailing Address - Phone:443-996-8187
Mailing Address - Fax:
Practice Address - Street 1:5702 SARGENT RD
Practice Address - Street 2:
Practice Address - City:CHILLUM
Practice Address - State:MD
Practice Address - Zip Code:20782-2321
Practice Address - Country:US
Practice Address - Phone:301-853-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD274421041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool