Basic Information
| Provider Information | |||||||||
| NPI: | 1487812152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAGERSTROM | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 509 | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047690509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077646825 | ||||||||
| FaxNumber: | 2077646077 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047692341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077649700 | ||||||||
| FaxNumber: | 2077649703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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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 | LC13884 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1487812152 | 05 | ME | MEDICAID |