Provider Demographics
NPI:1255446928
Name:SCHRADER, SANDRA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SUE
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DANIEL TRACE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1722
Mailing Address - Country:US
Mailing Address - Phone:860-321-7129
Mailing Address - Fax:860-742-5944
Practice Address - Street 1:80 DANIEL TRACE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1722
Practice Address - Country:US
Practice Address - Phone:860-321-7129
Practice Address - Fax:860-742-5944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist