Provider Demographics
NPI:1477536803
Name:KING, SARA C (MSW LICSW BCD)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:C
Last Name:KING
Suffix:
Gender:F
Credentials:MSW LICSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:19 COUNTY RD
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-0071
Mailing Address - Country:US
Mailing Address - Phone:508-758-3754
Mailing Address - Fax:508-758-3755
Practice Address - Street 1:19 COUNTY RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1584
Practice Address - Country:US
Practice Address - Phone:508-758-3754
Practice Address - Fax:508-758-3755
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1050841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
326002OtherTRICARE
105084OtherTUFTS
2176964OtherCIGNA
6229366OtherUBH
013746OtherPACIFICAR
MA1851314Medicaid
326002OtherTRICARE