Provider Demographics
NPI:1376023580
Name:MCCRACKEN, SARAH (LICSW, CIMHP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LICSW, CIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2555
Mailing Address - Country:US
Mailing Address - Phone:724-813-9018
Mailing Address - Fax:
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465
Practice Address - Country:US
Practice Address - Phone:724-813-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0217241041C0700X
NCC0134581041C0700X
VT089.01345341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical