Provider Demographics
NPI:1609880319
Name:DEMETRY, SARA J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:J
Last Name:DEMETRY
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:PO BOX 4141
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-4141
Mailing Address - Country:US
Mailing Address - Phone:802-274-6400
Mailing Address - Fax:877-681-3291
Practice Address - Street 1:1097 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2646
Practice Address - Country:US
Practice Address - Phone:802-274-6400
Practice Address - Fax:877-681-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900010551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012661Medicaid
VT1012661Medicaid