Provider Demographics
NPI:1063564193
Name:STAHL, SHARON A (MA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:A
Last Name:STAHL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 CABOT PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:VT
Mailing Address - Zip Code:05647-9785
Mailing Address - Country:US
Mailing Address - Phone:802-563-2292
Mailing Address - Fax:
Practice Address - Street 1:162 ELM ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2896
Practice Address - Country:US
Practice Address - Phone:802-229-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000291101YP2500X
VT0470000655103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005898Medicaid