1194819847 NPI number — MRS. SARA D NOLAN LICSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194819847 NPI number — MRS. SARA D NOLAN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAN
Provider First Name:
SARA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194819847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 778
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05257-0778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-442-2000
Provider Business Mailing Address Fax Number:
866-830-0802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 BANK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05257-0778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-442-2000
Provider Business Practice Location Address Fax Number:
866-830-0802
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  089-0001007 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0012942 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1010561 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 558538000 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 4145436 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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