Provider Demographics
NPI:1376630004
Name:PETERS, SANDRA JOAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JOAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LEDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1116
Mailing Address - Country:US
Mailing Address - Phone:617-777-4959
Mailing Address - Fax:508-229-0679
Practice Address - Street 1:11 LEDGE HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1116
Practice Address - Country:US
Practice Address - Phone:617-777-4959
Practice Address - Fax:508-229-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health