Provider Demographics
NPI:1114212271
Name:VALLEY COURT DIVERSION PROGRAMS
Entity Type:Organization
Organization Name:VALLEY COURT DIVERSION PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGENNARO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC
Authorized Official - Phone:802-295-5078
Mailing Address - Street 1:211 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-7045
Mailing Address - Country:US
Mailing Address - Phone:802-295-5078
Mailing Address - Fax:802-295-8833
Practice Address - Street 1:211 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7045
Practice Address - Country:US
Practice Address - Phone:802-295-5078
Practice Address - Fax:802-295-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000181251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health