Provider Demographics
NPI:1326160441
Name:SANGARASIVAM, SANTOSH (LCMHC)
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:SANGARASIVAM
Suffix:
Gender:F
Credentials:LCMHC
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 823
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0823
Mailing Address - Country:US
Mailing Address - Phone:603-643-3882
Mailing Address - Fax:603-643-3882
Practice Address - Street 1:205 BILLINGS FARM ROAD
Practice Address - Street 2:UNIT 1
Practice Address - City:WILDER
Practice Address - State:VT
Practice Address - Zip Code:05088
Practice Address - Country:US
Practice Address - Phone:603-643-3882
Practice Address - Fax:603-643-3882
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT07SMS58211103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist