Provider Demographics
NPI:1669683975
Name:SANDITEN, JUDITH MARIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MARIE
Last Name:SANDITEN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6029
Mailing Address - Country:US
Mailing Address - Phone:617-734-7282
Mailing Address - Fax:
Practice Address - Street 1:43 CLARK RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6029
Practice Address - Country:US
Practice Address - Phone:617-734-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical