Provider Demographics
NPI:1053147314
Name:PETRITES, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PETRITES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 CLAY CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9562
Mailing Address - Country:US
Mailing Address - Phone:317-733-6450
Mailing Address - Fax:
Practice Address - Street 1:12025 CLAY CENTER RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9562
Practice Address - Country:US
Practice Address - Phone:317-733-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool