Provider Demographics
NPI:1174681985
Name:EHLINGER, SANDRA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:EHLINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 WASHINGTON STREET
Mailing Address - Street 2:DORCHESTER DISTRICT COURT CLINIC
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124
Mailing Address - Country:US
Mailing Address - Phone:617-288-9500
Mailing Address - Fax:617-288-2360
Practice Address - Street 1:510 WASHINGTON ST
Practice Address - Street 2:DORCHESTER DISTRICT COURT CLINIC
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2046
Practice Address - Country:US
Practice Address - Phone:617-288-9500
Practice Address - Fax:617-288-2360
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2210103T00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02431Medicare ID - Type Unspecified