Provider Demographics
NPI:1467528208
Name:BOOTS, SANDRA MCCRAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MCCRAE
Last Name:BOOTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3013
Mailing Address - Country:US
Mailing Address - Phone:301-585-8376
Mailing Address - Fax:
Practice Address - Street 1:5415 CONNECTICUT AVE NW STE T43
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2786
Practice Address - Country:US
Practice Address - Phone:202-362-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC300363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC57-19-48Medicare PIN