Provider Demographics
NPI:1700355823
Name:ROBERTSON MUHAMMAD, SANDRA (MED, CAGS, LMHC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ROBERTSON MUHAMMAD
Suffix:
Gender:F
Credentials:MED, CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 DORCHESTER AVE # MA
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2556
Mailing Address - Country:US
Mailing Address - Phone:617-312-4476
Mailing Address - Fax:617-297-5515
Practice Address - Street 1:1773 DORCHESTER AVE # MA
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-2556
Practice Address - Country:US
Practice Address - Phone:617-312-4476
Practice Address - Fax:617-297-5515
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10186251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health