Active NPI
Sara Degennaro, MA, LCMHC, LADC,CCS
- Addiction (Substance Use Disorder) Counselor
- White River Junction, VT
National Provider Identifier
1386693091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 000059
- Practice address
- 211 N Main St
Suite B
White River Junction, VT 05001-7045 - Phone
- (802) 233-8755
- Fax
- (802) 295-8833
- NPI assigned
- May 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 000059 | VT | Primary |
| Mental Health Counselor | 101YM0800X | 0680000181 | VT | |
| Mental Health Counselor | 101YM0800X | 374 | NH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0600 | NH |
Addresses
Primary practice location
211 N Main St
Suite B
White River Junction, VT 05001-7045
Mailing address
PO Box 576
Ascutney, VT 05030
Phone (802) 295-0755
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29434 | Other | VT | MH BC/BS |
| 1006714 | Medicaid | VT | |
| 3100214 | Medicaid | NH | |
| 49993 | Other | VT | SA BC/BS |
| 30422317 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000059 | VT | MD | Addiction (Substance Use Disorder) Counselor |
| 0680000181 | VT | MD | Mental Health Counselor |
| 374 | NH | MD | Clinical Social Worker |
| 0600 | NH | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444694400000",
"number": "1386693091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 576",
"city": "ASCUTNEY",
"state": "VT",
"postal_code": "05030",
"telephone_number": "802-295-0755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 N MAIN ST",
"address_2": "SUITE B",
"city": "WHITE RIVER JUNCTION",
"state": "VT",
"postal_code": "050017045",
"telephone_number": "802-233-8755",
"fax_number": "802-295-8833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEGENNARO",
"first_name": "SARA",
"credential": "MA, LCMHC, LADC,CCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-09",
"last_updated": "2015-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "VT",
"license": "000059",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "0680000181",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NH",
"license": "374",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NH",
"license": "0600",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MH BC/BS",
"identifier": "29434",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1006714",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3100214",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SA BC/BS",
"identifier": "49993",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30422317",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in White River Junction, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.