Provider Demographics
NPI:1255170106
Name:WANDERLEY, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WANDERLEY
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 1:78 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-7249
Mailing Address - Country:US
Mailing Address - Phone:401-601-6556
Mailing Address - Fax:
Practice Address - Street 1:78 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-7249
Practice Address - Country:US
Practice Address - Phone:401-601-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst