Provider Demographics
NPI:1861570251
Name:GRANBERG, SARAH LYNN (LCSW, MAC, CTTS, SAP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LYNN
Last Name:GRANBERG
Suffix:
Gender:F
Credentials:LCSW, MAC, CTTS, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 MCCOY WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2314
Mailing Address - Country:US
Mailing Address - Phone:502-548-8878
Mailing Address - Fax:502-785-4003
Practice Address - Street 1:1949 GOLDSMITH LN STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3096
Practice Address - Country:US
Practice Address - Phone:502-548-8878
Practice Address - Fax:502-785-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100549480Medicaid