Provider Demographics
NPI:1386782951
Name:WAKEFIELD, SARAH A (LCPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:WAKEFIELD
Other - Last Name:KENEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 W AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8552
Mailing Address - Country:US
Mailing Address - Phone:207-576-7650
Mailing Address - Fax:
Practice Address - Street 1:345 W AUBURN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8552
Practice Address - Country:US
Practice Address - Phone:207-576-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000448101YM0800X
MECC4881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y0000892VT01OtherBLUE CROSS BLUE SHIELD
VT48116OtherBLUE CROSS BLUE SHIELD
VT1006716Medicaid