Provider Demographics
NPI:1427621895
Name:SMALL, SARAH J (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:SMALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9383
Mailing Address - Country:US
Mailing Address - Phone:973-494-4093
Mailing Address - Fax:
Practice Address - Street 1:1 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1389
Practice Address - Country:US
Practice Address - Phone:585-310-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091989-011041C0700X
NJ44SC054327001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical