Provider Demographics
NPI:1558398495
Name:OSSENFORT, SARAH JEAN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEAN
Last Name:OSSENFORT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:CATERINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:617 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1601
Mailing Address - Country:US
Mailing Address - Phone:802-864-6309
Mailing Address - Fax:802-860-4324
Practice Address - Street 1:THE FAMILY COUNSELING CENTER
Practice Address - Street 2:11 BROADWAY
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078
Practice Address - Country:US
Practice Address - Phone:518-725-4310
Practice Address - Fax:802-860-4324
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900008661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00069858OtherBLUE CROSS BLUE SHIELD
VT1008185Medicaid
NYRB0288Medicare ID - Type Unspecified