Provider Demographics
NPI:1811025968
Name:BECKETT, SARAH R (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:BECKETT
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:SALLIE
Other - Middle Name:R
Other - Last Name:GASCOYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249
Mailing Address - Country:US
Mailing Address - Phone:860-642-7928
Mailing Address - Fax:860-376-5878
Practice Address - Street 1:121 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-887-3626
Practice Address - Fax:860-376-5878
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0022561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
134409OtherVALUE OPTIONS
CTP2565117OtherOXFORD
CT140002256CT01OtherANTHEM
188485OtherMHN