Provider Demographics
NPI:1447405733
Name:DUPONT, SARA JEANNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JEANNE
Last Name:DUPONT
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 1:79 KAULBACK RD
Mailing Address - Street 2:
Mailing Address - City:SANBORNTON
Mailing Address - State:NH
Mailing Address - Zip Code:03269-2811
Mailing Address - Country:US
Mailing Address - Phone:603-520-5426
Mailing Address - Fax:
Practice Address - Street 1:635 MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3415
Practice Address - Country:US
Practice Address - Phone:603-507-6477
Practice Address - Fax:855-822-0419
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2270104100000X, 101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health