Provider Demographics
NPI:1598584666
Name:SAYRE, SOPHIE RAE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:RAE
Last Name:SAYRE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:SOPHIE
Other - Middle Name:RAE
Other - Last Name:KOTECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOPHIE RAE KOTECKI
Mailing Address - Street 1:110 COURT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1273
Mailing Address - Country:US
Mailing Address - Phone:860-613-9930
Mailing Address - Fax:860-613-9952
Practice Address - Street 1:110 COURT ST STE 3
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1273
Practice Address - Country:US
Practice Address - Phone:860-613-9930
Practice Address - Fax:860-613-9952
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8991104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker