Basic Information
| Provider Information | |||||||||
| NPI: | 1215222682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REIDY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7004 BEE CAVE RD. | ||||||||
| Address2: | BLD. 2, STE. 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123247000 | ||||||||
| FaxNumber: | 5123248616 | ||||||||
| Practice Location | |||||||||
| Address1: | 1313 RED RIVER ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123247000 | ||||||||
| FaxNumber: | 5123248616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 11/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 39960 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 284467201 | 05 | TX | MEDICAID |