Provider Demographics
NPI:1689431751
Name:SAGE MENTAL HEALTH PLC
Entity Type:Organization
Organization Name:SAGE MENTAL HEALTH PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEBOEUF
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:802-535-2176
Mailing Address - Street 1:192 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8865
Mailing Address - Country:US
Mailing Address - Phone:802-535-2176
Mailing Address - Fax:
Practice Address - Street 1:33 OAK ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5329
Practice Address - Country:US
Practice Address - Phone:802-473-1213
Practice Address - Fax:802-200-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty