Provider Demographics
NPI:1689235970
Name:SARA DIANE NOLAN, LICSW, PLC
Entity type:Organization
Organization Name:SARA DIANE NOLAN, LICSW, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-442-2000
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-0778
Mailing Address - Country:US
Mailing Address - Phone:802-442-2000
Mailing Address - Fax:866-830-0802
Practice Address - Street 1:5 BANK STREET
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257
Practice Address - Country:US
Practice Address - Phone:802-442-2000
Practice Address - Fax:866-830-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty