Provider Demographics
NPI:1780648436
Name:CAMBRA, SANDRA JEAN (LICSW BCD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JEAN
Last Name:CAMBRA
Suffix:
Gender:F
Credentials:LICSW BCD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:DESOUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53 LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1512
Mailing Address - Country:US
Mailing Address - Phone:508-264-9007
Mailing Address - Fax:508-238-0299
Practice Address - Street 1:32 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375
Practice Address - Country:US
Practice Address - Phone:508-264-9007
Practice Address - Fax:508-238-0299
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1851586Medicaid
573301OtherPACIFICARE
7159437OtherAETNA
A021199OtherVALUE OPTIONS
1040860OtherBEACON
MA110031560AMedicaid
RI228251OtherBCBSRI
MAP07893OtherBCBSMA
344120000OtherMAGELLAN
RI410158OtherBCBSRI BLUE CHIP
7159437OtherAETNA