Provider Demographics
NPI:1003206855
Name:SARGENT, MICHAEL STANSFELD (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STANSFELD
Last Name:SARGENT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1232
Mailing Address - Country:US
Mailing Address - Phone:413-448-5358
Mailing Address - Fax:413-448-2662
Practice Address - Street 1:120 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2203
Practice Address - Country:US
Practice Address - Phone:413-448-5358
Practice Address - Fax:413-448-2662
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220459104100000X
MA1202971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker