Provider Demographics
NPI:1497835185
Name:CORMIER, SANDRA CANO (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:CANO
Last Name:CORMIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MANCHACA RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5371
Mailing Address - Country:US
Mailing Address - Phone:512-851-6381
Mailing Address - Fax:512-276-6759
Practice Address - Street 1:8700 MANCHACA RD
Practice Address - Street 2:SUITE 402
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5371
Practice Address - Country:US
Practice Address - Phone:512-851-6381
Practice Address - Fax:512-276-6759
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30676103T00000X
HI917103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist