Provider Demographics
NPI:1083923734
Name:DUMART, SANDRA JOHNSON
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOHNSON
Last Name:DUMART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 OAKLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2744
Mailing Address - Country:US
Mailing Address - Phone:508-541-4642
Mailing Address - Fax:
Practice Address - Street 1:38 POND ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3807
Practice Address - Country:US
Practice Address - Phone:508-528-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist