Provider Demographics
NPI:1194819847
Name:NOLAN, SARA D (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:D
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-0778
Mailing Address - Country:US
Mailing Address - Phone:802-442-2000
Mailing Address - Fax:866-830-0802
Practice Address - Street 1:5 BANK STREET
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257-0778
Practice Address - Country:US
Practice Address - Phone:802-442-2000
Practice Address - Fax:866-830-0802
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00010071041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0012942OtherMEDICARE PTAN
VT1010561Medicaid
VT558538000OtherBLUE CROSS/BLUE SHIELD
VT4145436OtherMVP