Provider Demographics
NPI:1073839619
Name:HOUDE, SANDRA ALEXIS (LICSW,CGP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ALEXIS
Last Name:HOUDE
Suffix:
Gender:F
Credentials:LICSW,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JEAN RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3204
Mailing Address - Country:US
Mailing Address - Phone:781-646-2897
Mailing Address - Fax:
Practice Address - Street 1:344 HARVARD ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2917
Practice Address - Country:US
Practice Address - Phone:781-646-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health