Provider Demographics
NPI:1902010267
Name:GILLEN, SARAH (MA)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:GILLEN
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 1:174 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2262
Mailing Address - Country:US
Mailing Address - Phone:802-229-4815
Mailing Address - Fax:802-229-4811
Practice Address - Street 1:174 ELM ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2262
Practice Address - Country:US
Practice Address - Phone:802-229-4815
Practice Address - Fax:802-229-4811
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100-0000011106H00000X
CAMFC 18048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist