1780648436 NPI number — MRS. SANDRA JEAN CAMBRA LICSW BCD

Table of content: SON CHU MEROLA (NPI 1538577226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780648436 NPI number — MRS. SANDRA JEAN CAMBRA LICSW BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMBRA
Provider First Name:
SANDRA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESOUSA
Provider Other First Name:
SANDRA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780648436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 LAKESIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-264-9007
Provider Business Mailing Address Fax Number:
508-238-0299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 NORFOLK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH EASTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-264-9007
Provider Business Practice Location Address Fax Number:
508-238-0299
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  110664 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1851586 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 573301 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7159437 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A021199 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1040860 . This is a "BEACON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110031560A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228251 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: P07893 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 344120000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410158 . This is a "BCBSRI BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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