Healthcare Provider Details

I. General information

NPI: 1447405733
Provider Name (Legal Business Name): SARA JEANNE DUPONT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MAIN ST STE 303
LACONIA NH
03246-3415
US

IV. Provider business mailing address

79 KAULBACK RD
SANBORNTON NH
03269-2811
US

V. Phone/Fax

Practice location:
  • Phone: 603-507-6477
  • Fax: 855-822-0419
Mailing address:
  • Phone: 603-520-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2270
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2270
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: