MEDICARE: SARA JANE BOOTH MA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1598914053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JANE BOOTH MA

Provider Business Mailing Address
First Line	:	9 CENTENNIAL DR
Second Line	:	SUITE 202
City	:	PEABODY
State	:	MA
Zip	:	01960-7939
Country	:	US
Telephone Number	:	978-927-9410
Fax Number	:	978-531-1355

Provider Business Practice Location Address
First Line	:	9 CENTENNIAL DR
Second Line	:	SUITE 202
City	:	PEABODY
State	:	MA
Zip	:	01960-7939
Country	:	US
Telephone Number	:	978-927-9410
Fax Number	:	978-531-1355

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

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	12/09/2010

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Directions to “ SARA JANE BOOTH MA” Practice Location

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