MEDICARE: SIERRA L. HARGRAVE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	068.0137113	VT

General Provider Information

NPI Number	:	1902769110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA L. HARGRAVE MA

Provider Business Mailing Address
First Line	:	PO BOX 647
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05601-0647
Country	:	US
Telephone Number	:	802-225-8355
Fax Number	:	802-223-8105

Provider Business Practice Location Address
First Line	:	73 MAIN ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-2932
Country	:	US
Telephone Number	:	802-225-8355
Fax Number	:	802-223-8105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	03/16/2026

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