1003977216 NPI number — DR. MARIE T. SANDOLI PH.D., L.I.C.S.W.

Table of content: DR. MARIE T. SANDOLI PH.D., L.I.C.S.W. (NPI 1003977216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003977216 NPI number — DR. MARIE T. SANDOLI PH.D., L.I.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDOLI
Provider First Name:
MARIE
Provider Middle Name:
T.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., L.I.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003977216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BROOKFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01515-0665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-867-7267
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 PHEASANT CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01501-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-832-2953
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 1017526 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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