Provider Demographics
NPI:1538176987
Name:SACKS, LCSW, CATHERINE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SACKS, LCSW
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CATHRYN
Other - Middle Name:
Other - Last Name:JESPERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1110 ROSE HILL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5159
Mailing Address - Country:US
Mailing Address - Phone:434-979-0401
Mailing Address - Fax:434-220-3335
Practice Address - Street 1:1110 ROSE HILL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5159
Practice Address - Country:US
Practice Address - Phone:434-979-0401
Practice Address - Fax:434-220-3335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040022051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141570OtherANTHEM
VA008944512Medicaid
VA083485OtherSENTARA BEHAVIORAL HEALTH