Provider Demographics
NPI:1194166397
Name:DIONNE, SARAH MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:DIONNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:PULSIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:376 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1625
Mailing Address - Country:US
Mailing Address - Phone:207-333-8521
Mailing Address - Fax:
Practice Address - Street 1:52 OAK ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2078
Practice Address - Country:US
Practice Address - Phone:207-333-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MELC155171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA119811OtherMA LICENSE