Provider Demographics
NPI:1730897778
Name:SARA J DEMETRY
Entity type:Organization
Organization Name:SARA J DEMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETRY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-274-6400
Mailing Address - Street 1:PO BOX 4141
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-4141
Mailing Address - Country:US
Mailing Address - Phone:802-274-6400
Mailing Address - Fax:877-681-3291
Practice Address - Street 1:1097 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2646
Practice Address - Country:US
Practice Address - Phone:802-274-6400
Practice Address - Fax:877-681-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012661Medicaid