Provider Demographics
NPI:1003142092
Name:BENTON, SARAH A (LMHC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:BENTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ALDWORTH ST
Mailing Address - Street 2:#1
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2715
Mailing Address - Country:US
Mailing Address - Phone:508-830-0012
Mailing Address - Fax:508-830-0092
Practice Address - Street 1:34 MAIN STREET EXT
Practice Address - Street 2:SUITE 103
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8302
Practice Address - Country:US
Practice Address - Phone:508-830-0012
Practice Address - Fax:508-830-0092
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health