Healthcare Provider Details

I. General information

NPI: 1811025968
Provider Name (Legal Business Name): SARAH R BECKETT MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALLIE R GASCOYNE

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LAFAYETTE ST
NORWICH CT
06360
US

IV. Provider business mailing address

PO BOX 206
LEBANON CT
06249
US

V. Phone/Fax

Practice location:
  • Phone: 860-887-3626
  • Fax: 860-376-5878
Mailing address:
  • Phone: 860-642-7928
  • Fax: 860-376-5878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002256
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: