Provider Demographics
NPI:1457711624
Name:CHAN, SARAH (MSW, LISW-S)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CHAN
Suffix:
Gender:
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BENEDETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LISW-S
Mailing Address - Street 1:599 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1541
Mailing Address - Country:US
Mailing Address - Phone:719-556-7804
Mailing Address - Fax:
Practice Address - Street 1:599 VINCENT ST
Practice Address - Street 2:
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-556-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 1450840 SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical