Provider Demographics
NPI:1275095572
Name:SANDER, REBECCA E
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E
Last Name:SANDER
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 1:1937 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-4010
Mailing Address - Country:US
Mailing Address - Phone:802-579-5684
Mailing Address - Fax:
Practice Address - Street 1:202 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6508
Practice Address - Country:US
Practice Address - Phone:207-941-6434
Practice Address - Fax:207-941-9366
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXM5671106H00000X
MEMF6974106H00000X
METXM5833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist