Provider Demographics
NPI:1003977216
Name:SANDOLI, MARIE T (PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:T
Last Name:SANDOLI
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:EAST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01515-0665
Mailing Address - Country:US
Mailing Address - Phone:508-867-7267
Mailing Address - Fax:
Practice Address - Street 1:21 PHEASANT CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2457
Practice Address - Country:US
Practice Address - Phone:508-832-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP1600X
MA10175261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical