Provider Demographics
NPI:1790193985
Name:SANBORN, JENNIFER (MS, LADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SANBORN
Suffix:
Gender:F
Credentials:MS, LADC
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 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5810
Mailing Address - Fax:802-371-4821
Practice Address - Street 1:246 GRANGER RD.
Practice Address - Street 2:SUITE 2
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-225-5810
Practice Address - Fax:802-371-4821
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000631101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)