Provider Demographics
NPI:1518448497
Name:ROBICHAUD, SANDRA MELDONIAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MELDONIAN
Last Name:ROBICHAUD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NANCY RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2631
Mailing Address - Country:US
Mailing Address - Phone:978-369-9064
Mailing Address - Fax:
Practice Address - Street 1:25 NANCY RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2631
Practice Address - Country:US
Practice Address - Phone:978-369-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017964-SW-LICSW104100000X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1017964-SW-LICSWOtherCOMMONWEALTH OF MASSACHUSETTS