Provider Demographics
NPI:1639652001
Name:WOODBURN-BLOCKER, SANDRA (LICSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WOODBURN-BLOCKER
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 1:2 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3629
Mailing Address - Country:US
Mailing Address - Phone:978-857-6472
Mailing Address - Fax:
Practice Address - Street 1:2 APPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3629
Practice Address - Country:US
Practice Address - Phone:978-857-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107613-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical