Provider Demographics
NPI:1609472588
Name:GEOGHEGAN, SARA DAVIDSON (APSW)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:DAVIDSON
Last Name:GEOGHEGAN
Suffix:
Gender:
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 GUYENCOURT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-1415
Mailing Address - Country:US
Mailing Address - Phone:302-300-6615
Mailing Address - Fax:
Practice Address - Street 1:100 W ROCKLAND RD STE K-1
Practice Address - Street 2:
Practice Address - City:MONTCHANIN
Practice Address - State:DE
Practice Address - Zip Code:19710-2006
Practice Address - Country:US
Practice Address - Phone:302-365-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009923100104100000X
WI19513875104100000X
DEQ1-00125361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker