Provider Demographics
NPI:1942209374
Name:SANDMAN, NANCY GOULD (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:GOULD
Last Name:SANDMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:GOULD
Other - Last Name:SANDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:115 SEWALL AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5344
Mailing Address - Country:US
Mailing Address - Phone:617-731-2707
Mailing Address - Fax:866-808-5482
Practice Address - Street 1:115 SEWALL AVE
Practice Address - Street 2:APT 4
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5344
Practice Address - Country:US
Practice Address - Phone:617-731-2707
Practice Address - Fax:866-808-5482
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO159101Medicare PIN