Provider Demographics
NPI:1386693091
Name:DEGENNARO, SARA (MA, LCMHC, LADC,CCS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DEGENNARO
Suffix:
Gender:F
Credentials:MA, LCMHC, LADC,CCS
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 576
Mailing Address - Street 2:
Mailing Address - City:ASCUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05030
Mailing Address - Country:US
Mailing Address - Phone:802-295-0755
Mailing Address - Fax:
Practice Address - Street 1:211 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7045
Practice Address - Country:US
Practice Address - Phone:802-233-8755
Practice Address - Fax:802-295-8833
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000059101YA0400X
VT0680000181101YM0800X
NH374101YM0800X
NH0600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT29434OtherMH BC/BS
VT1006714Medicaid
NH3100214Medicaid
VT49993OtherSA BC/BS
NH30422317Medicaid