Provider Demographics
NPI:1386118198
Name:DARROW, LARA (MA, LCMHC, RSMT, RYT)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:DARROW
Suffix:
Gender:F
Credentials:MA, LCMHC, RSMT, RYT
Other - Prefix:MRS
Other - First Name:LARA
Other - Middle Name:DARROW
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCMHC, RSMT, RYT
Mailing Address - Street 1:295 GRASSY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:VT
Mailing Address - Zip Code:05345-9744
Mailing Address - Country:US
Mailing Address - Phone:802-598-1245
Mailing Address - Fax:
Practice Address - Street 1:295 GRASSY BROOK RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:VT
Practice Address - Zip Code:05345-9744
Practice Address - Country:US
Practice Address - Phone:802-598-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0131485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT068.0131485Medicaid