Individual provider Active NPI

Sara Jane Moss, LICSW

  • Social Worker
  • Brattleboro, VT
National Provider Identifier
1619018017
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
0890000121 Issued in VT
Practice address
38 Park Place
Brattleboro, VT 05302-0511
Phone
(802) 257-2238
NPI assigned
Feb 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 0890000121 VT Primary

Addresses

Primary practice location

38 Park Place
Brattleboro, VT 05302-0511

Mailing address

PO Box 511
Brattleboro, VT 05302-0511
Phone (802) 257-2238

Other identifiers 1

IdentifierTypeStateIssuer
0805044OtherVTBCBS

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
0890000121VTMDSocial Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619018017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053020511",
            "telephone_number": "802-257-2238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 PARK PLACE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053020511",
            "telephone_number": "802-257-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "SARA",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "VT",
            "license": "0890000121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0805044",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brattleboro, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.