Provider Demographics
NPI:1407420565
Name:SARAH BRADLEY, PLC
Entity Type:Organization
Organization Name:SARAH BRADLEY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCMHC
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHC
Authorized Official - Phone:317-987-2096
Mailing Address - Street 1:4 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3607
Mailing Address - Country:US
Mailing Address - Phone:317-987-2096
Mailing Address - Fax:
Practice Address - Street 1:45 SAN REMO DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6312
Practice Address - Country:US
Practice Address - Phone:802-662-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1025974Medicaid