Provider Demographics
NPI:1407728926
Name:SANINOCENCIO, IVANA FELICE
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:FELICE
Last Name:SANINOCENCIO
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 1:188 WINDHAM RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-2256
Mailing Address - Country:US
Mailing Address - Phone:978-364-7559
Mailing Address - Fax:
Practice Address - Street 1:188 WINDHAM RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-2256
Practice Address - Country:US
Practice Address - Phone:978-364-7559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty