Provider Demographics
NPI:1568565992
Name:RONAN, SANDRA DAHL (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DAHL
Last Name:RONAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:DAHL RONAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3710
Mailing Address - Country:US
Mailing Address - Phone:978-281-4067
Mailing Address - Fax:
Practice Address - Street 1:92 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3710
Practice Address - Country:US
Practice Address - Phone:978-281-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1039551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0596419OtherAETNA
1013896OtherCIGNA
MA721517OtherTUFTS
000531000OtherMAGELLAN
MA1006790OtherBEACON
000531000OtherMAGELLAN