Provider Demographics
NPI:1376792234
Name:PLUMMER, SANDRA LOUISE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LOUISE
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LOUISE
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 PENDLETON DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1525
Mailing Address - Country:US
Mailing Address - Phone:860-228-9488
Mailing Address - Fax:860-228-1213
Practice Address - Street 1:25 PENDLETON DRIVE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1525
Practice Address - Country:US
Practice Address - Phone:860-228-9488
Practice Address - Fax:860-228-1213
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004259447Medicaid