Provider Demographics
NPI:1366076861
Name:KATTIRTZI, SARA JANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JANE
Last Name:KATTIRTZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:SENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:217 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:N GROSVENORDL
Mailing Address - State:CT
Mailing Address - Zip Code:06255-1503
Mailing Address - Country:US
Mailing Address - Phone:203-218-3170
Mailing Address - Fax:
Practice Address - Street 1:49 WHITEHALL AVE
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1966
Practice Address - Country:US
Practice Address - Phone:860-961-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0099731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical