Provider Demographics
NPI:1568865236
Name:DR SARA CLEMENTS LLC
Entity Type:Organization
Organization Name:DR SARA CLEMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST DOCTORATE
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-497-0363
Mailing Address - Street 1:125 COLLEGE ST
Mailing Address - Street 2:1
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8444
Mailing Address - Country:US
Mailing Address - Phone:802-497-0363
Mailing Address - Fax:
Practice Address - Street 1:125 COLLEGE ST
Practice Address - Street 2:1
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8444
Practice Address - Country:US
Practice Address - Phone:802-497-0363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0072012103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty