Provider Demographics
NPI:1699955385
Name:PERNICE, SARA MICHELLE (BA)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:MICHELLE
Last Name:PERNICE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CAROLYN RD
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-3005
Mailing Address - Country:US
Mailing Address - Phone:781-595-2413
Mailing Address - Fax:781-598-0210
Practice Address - Street 1:43 CAROLYN RD
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-3005
Practice Address - Country:US
Practice Address - Phone:781-595-2413
Practice Address - Fax:781-598-0210
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)