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General NPI Number Information
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NPI Number | 1568865236
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Entity Type | Organization
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Legal Business Name | DR SARA CLEMENTS LLC
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 125 COLLEGE ST 1
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City | BURLINGTON
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State | VT
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Zip | 05401-8444
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Country | US
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Telephone | 802-497-0363
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Fax |
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Provider Business Mailing Address
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Address Line | 125 COLLEGE ST 1
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City | BURLINGTON
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State | VT
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Zip | 05401-8444
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Country | US
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Telephone | 802-497-0363
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST DOCTORATE
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Name | DR. SARA MARIE CLEMENTS
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Credential | PSYD
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Telephone | 802-497-0363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 048.0072012
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License Number State | VT
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