Provider Demographics
NPI:1487729703
Name:COLE, LOREN SARA (LICSW)
Entity type:Individual
Prefix:MS
First Name:LOREN
Middle Name:SARA
Last Name:COLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2827
Mailing Address - Country:US
Mailing Address - Phone:802-257-4555
Mailing Address - Fax:802-254-1111
Practice Address - Street 1:38 PARK PL
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2827
Practice Address - Country:US
Practice Address - Phone:802-257-4555
Practice Address - Fax:802-254-1111
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0890000247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0492Medicaid
VT8370OtherBLUE CROSS BLUE SHIELD
COVN0492Medicare UPIN
VTCOVN0492Medicare ID - Type Unspecified