Provider Demographics
NPI:1699166363
Name:USTINOV, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:USTINOV
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:SOUTH GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04359-0039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 BAKER ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357-1387
Practice Address - Country:US
Practice Address - Phone:207-358-0505
Practice Address - Fax:888-972-3885
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1393103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical