Provider Demographics
NPI:1518440056
Name:GREATHOUSE, SARA R (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 VILLAGE OAK LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2784
Mailing Address - Country:US
Mailing Address - Phone:330-774-4632
Mailing Address - Fax:
Practice Address - Street 1:711 BELMONT AVE STE 2
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1039
Practice Address - Country:US
Practice Address - Phone:330-793-2487
Practice Address - Fax:330-743-5748
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW23295101YM0800X
171M00000X
OHS.2207286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator