Provider Demographics
NPI:1184519563
Name:MOALLEM-WOOD, SARA CHRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:CHRISTINE
Last Name:MOALLEM-WOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 MORTON WAY
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-9601
Mailing Address - Country:US
Mailing Address - Phone:321-626-5397
Mailing Address - Fax:
Practice Address - Street 1:3103 MORTON WAY
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9601
Practice Address - Country:US
Practice Address - Phone:321-626-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW235381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical