Provider Demographics
NPI:1689816423
Name:SANDRA KAY WIENS, PHD, LLC
Entity Type:Organization
Organization Name:SANDRA KAY WIENS, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-453-1781
Mailing Address - Street 1:36 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2349
Mailing Address - Country:US
Mailing Address - Phone:203-453-1781
Mailing Address - Fax:203-453-1781
Practice Address - Street 1:26 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1870
Practice Address - Country:US
Practice Address - Phone:203-453-1781
Practice Address - Fax:203-453-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty