Provider Demographics
NPI:1528185014
Name:EATON, SANDRA CAROL (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:CAROL
Last Name:EATON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PEACOCK FARM RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6342
Mailing Address - Country:US
Mailing Address - Phone:781-861-7642
Mailing Address - Fax:781-861-7642
Practice Address - Street 1:51 PEACOCK FARM RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6342
Practice Address - Country:US
Practice Address - Phone:781-861-7642
Practice Address - Fax:781-861-7642
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health