Basic Information
| Provider Information | |||||||||
| NPI: | 1801981295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENOIT | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STUART | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | JANE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LICSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 125 CHURCH ST | ||||||||
| Address2: | SUITE 90-104 | ||||||||
| City: | PEMBROKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023591929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817546545 | ||||||||
| FaxNumber: | 7815360016 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 CHURCH ST | ||||||||
| Address2: | SUITE 90-104 | ||||||||
| City: | PEMBROKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023591929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817546545 | ||||||||
| FaxNumber: | 7815360016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 113211 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P08597 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |