Provider Demographics
NPI:1679875009
Name:DELLACROCE, SANDRA JEAN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:DELLACROCE
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:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-0495
Mailing Address - Country:US
Mailing Address - Phone:508-400-0101
Mailing Address - Fax:
Practice Address - Street 1:8 ROGERS FIELD WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1803
Practice Address - Country:US
Practice Address - Phone:508-400-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health