Provider Demographics
NPI:1922345610
Name:PHILLIPS, SARA MECONIS (LICSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:MECONIS
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 UNIVERSITY AVE W.
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1860
Mailing Address - Country:US
Mailing Address - Phone:612-436-4840
Mailing Address - Fax:612-436-2606
Practice Address - Street 1:649 DAYTON AVE.
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6631
Practice Address - Country:US
Practice Address - Phone:612-436-4840
Practice Address - Fax:612-436-2604
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN270061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical