Provider Demographics
NPI:1285811265
Name:JAKUB, SARA ANN M (LPC)
Entity type:Individual
Prefix:MRS
First Name:SARA ANN
Middle Name:M
Last Name:JAKUB
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:GODERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:591 POQUONNOCK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4571
Mailing Address - Country:US
Mailing Address - Phone:860-449-8217
Mailing Address - Fax:860-449-8323
Practice Address - Street 1:591 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4571
Practice Address - Country:US
Practice Address - Phone:860-449-8217
Practice Address - Fax:860-449-8323
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health