Provider Demographics
NPI:1376754499
Name:LEBOW, SANDRA HERLICZEK (RN, MSN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:HERLICZEK
Last Name:LEBOW
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:WILSON
Other - Last Name:HERLICZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MS
Mailing Address - Street 1:5 HUTCHINSON LN
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2217
Mailing Address - Country:US
Mailing Address - Phone:413-637-4423
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01262
Practice Address - Country:US
Practice Address - Phone:413-298-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121025163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health