Provider Demographics
NPI:1114530714
Name:CROSSON, SANDRA MALOTT
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MALOTT
Last Name:CROSSON
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 1:8 SWAAN DR
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03861-6606
Mailing Address - Country:US
Mailing Address - Phone:603-781-1695
Mailing Address - Fax:
Practice Address - Street 1:8 SWAAN DR
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:NH
Practice Address - Zip Code:03861-6606
Practice Address - Country:US
Practice Address - Phone:603-781-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH37511103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool