Provider Demographics
NPI:1396611059
Name:SANDRE, JOELLE MIRANDA
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:MIRANDA
Last Name:SANDRE
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 1:505 RODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2120
Mailing Address - Country:US
Mailing Address - Phone:215-740-1360
Mailing Address - Fax:
Practice Address - Street 1:2 HIDDEN LN
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4603
Practice Address - Country:US
Practice Address - Phone:267-209-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty