Provider Demographics
NPI:1205223963
Name:STEWART, SARAH (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOLTON PL
Mailing Address - Street 2:YMCA MENTAL HEALTH CLINIC
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5316
Mailing Address - Country:US
Mailing Address - Phone:508-583-2155
Mailing Address - Fax:
Practice Address - Street 1:15 BOLTON PL
Practice Address - Street 2:YMCA MENTAL HEALTH CLINIC
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5316
Practice Address - Country:US
Practice Address - Phone:508-587-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1189531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical