Provider Demographics
NPI:1912179128
Name:WEISENBACH, SARA L (PHD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:WEISENBACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LOUISE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:115 MILL ST.
Mailing Address - Street 2:MAIL STOP 234
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1064
Mailing Address - Country:US
Mailing Address - Phone:617-855-3183
Mailing Address - Fax:
Practice Address - Street 1:115 MILL ST.
Practice Address - Street 2:MAIL STOP 234
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1064
Practice Address - Country:US
Practice Address - Phone:617-855-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023615103G00000X
MI6301013024103G00000X, 103TC0700X
MAPSY11828103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical