Provider Demographics
NPI:1851944292
Name:SUMPIO, SARAH TADDEI (LICSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:TADDEI
Last Name:SUMPIO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CATHERINE
Other - Last Name:TADDEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:WACC0037
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-643-7530
Mailing Address - Fax:617-726-7676
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-643-7530
Practice Address - Fax:617-726-7676
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA122343OtherNASW
MA110157295AMedicaid