Provider Demographics
NPI:1265944557
Name:MAISON, SARA JUSTINE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JUSTINE
Last Name:MAISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6266 FAIRFIELD AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2323
Mailing Address - Country:US
Mailing Address - Phone:727-465-3462
Mailing Address - Fax:
Practice Address - Street 1:1135 PASADENA AVE S STE 327B
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-6425
Practice Address - Country:US
Practice Address - Phone:727-465-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist