Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 220459 | MA |
NPI | 1003206855 |
---|---|
Provider Name | Mr. Michael Stansfeld Sargent |
First Address | Pittsfield, MA 01201-5156 |
Second Address | Pittsfield, MA 01201-5156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |