Provider Demographics
NPI:1619018017
Name:MOSS, SARA JANE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JANE
Last Name:MOSS
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 511
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0511
Mailing Address - Country:US
Mailing Address - Phone:802-257-2238
Mailing Address - Fax:
Practice Address - Street 1:38 PARK PLACE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05302-0511
Practice Address - Country:US
Practice Address - Phone:802-257-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0890000121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0805044OtherBCBS
VT9870Medicare ID - Type Unspecified