Basic Information
| Provider Information | |||||||||
| NPI: | 1003142092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENTON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 ALDWORTH ST | ||||||||
| Address2: | #1 | ||||||||
| City: | JAMAICA PLAIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021302715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088300012 | ||||||||
| FaxNumber: | 5088300092 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 MAIN STREET EXT | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023608302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088300012 | ||||||||
| FaxNumber: | 5088300092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2009 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6339 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.