Provider Demographics
NPI:1619030665
Name:CARLO, SANDRA ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:CARLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4860
Mailing Address - Country:US
Mailing Address - Phone:203-767-9629
Mailing Address - Fax:
Practice Address - Street 1:3380 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4860
Practice Address - Country:US
Practice Address - Phone:203-767-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7251549OtherAETNA PROVIDER ID
CT62-73452OtherUNITED HEALTHCARE ID
CT304198OtherMHN PROVIDER ID
CT410001010CT06OtherANTHEM BCBS PROVIDER ID
CTP3179321OtherOXFORD HEALTH PROVIDER ID