Provider Demographics
NPI:1184384042
Name:SEMBORSKI, SARA MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIA
Last Name:SEMBORSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4404
Mailing Address - Country:US
Mailing Address - Phone:570-204-6048
Mailing Address - Fax:
Practice Address - Street 1:1315 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4404
Practice Address - Country:US
Practice Address - Phone:570-204-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0199171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical