Provider Demographics
NPI:1790940914
Name:SANDMAN, PAUL HARRIS (EDD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HARRIS
Last Name:SANDMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GROVE ST
Mailing Address - Street 2:306
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2627
Mailing Address - Country:US
Mailing Address - Phone:774-329-9429
Mailing Address - Fax:
Practice Address - Street 1:100 GROVE ST
Practice Address - Street 2:306
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2627
Practice Address - Country:US
Practice Address - Phone:774-329-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002829101YM0800X
MA7074LMHC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health