Provider Demographics
NPI:1568875029
Name:DESROSIER, SARA LOUISE (LCSW, LADC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:DESROSIER
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1201
Mailing Address - Country:US
Mailing Address - Phone:207-295-7998
Mailing Address - Fax:207-728-9239
Practice Address - Street 1:112 11TH AVE
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1201
Practice Address - Country:US
Practice Address - Phone:207-295-7998
Practice Address - Fax:207-728-9239
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC8161101YA0400X
MELC177801041C0700X
MEMC16377104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1568875029Medicaid