Provider Demographics
NPI:1235735366
Name:BURGESS, SARAH MASON (LICSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MASON
Last Name:BURGESS
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 1:3 LANTHORN LN
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4721
Mailing Address - Country:US
Mailing Address - Phone:978-880-3668
Mailing Address - Fax:
Practice Address - Street 1:3 LANTHORN LN
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4721
Practice Address - Country:US
Practice Address - Phone:978-880-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1114241041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool