MEDICARE: MRS. SARAH GRACE HANLON LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1548594708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH GRACE HANLON LICSW

Provider Business Mailing Address
First Line	:	3313 WASHINGTON ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2691
Country	:	US
Telephone Number	:	617-548-1913
Fax Number	:

Provider Business Practice Location Address
First Line	:	3313 WASHINGTON ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2691
Country	:	US
Telephone Number	:	617-548-1913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	07/29/2022

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