Provider Demographics
NPI:1194332874
Name:DE PONS, SARA (LICSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DE PONS
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 1:83 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3041
Mailing Address - Country:US
Mailing Address - Phone:508-838-0226
Mailing Address - Fax:
Practice Address - Street 1:992 GREAT PLAIN AVE STE 22
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2524
Practice Address - Country:US
Practice Address - Phone:508-634-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1264791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical