Provider Demographics
NPI:1568715043
Name:APISUTIPORN, SADUDEE
Entity Type:Individual
Prefix:MISS
First Name:SADUDEE
Middle Name:
Last Name:APISUTIPORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODLAWN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4101
Mailing Address - Country:US
Mailing Address - Phone:857-445-5114
Mailing Address - Fax:
Practice Address - Street 1:19 WOODLAWN ST FL 3
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4101
Practice Address - Country:US
Practice Address - Phone:857-445-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health