Provider Demographics
NPI:1437257508
Name:CHASE, SARA ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:CHASE
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 1:36 BRICKYARD RD UNIT 17
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4324
Mailing Address - Country:US
Mailing Address - Phone:802-288-8051
Mailing Address - Fax:
Practice Address - Street 1:617 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1601
Practice Address - Country:US
Practice Address - Phone:802-864-6309
Practice Address - Fax:802-860-4324
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900009361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009608Medicaid
2294598OtherCIGNA BEHAVIORAL HEALTH
VT59326OtherBLUE CROSS BLUE SHIELD
576755OtherVALUE OPTIONS
VN3359Medicare ID - Type Unspecified