Provider Demographics
NPI:1720864457
Name:ACKERMAN, SANDRA LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SARAH PAUL HL
Mailing Address - Street 2:
Mailing Address - City:MADBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03823-7616
Mailing Address - Country:US
Mailing Address - Phone:603-553-1238
Mailing Address - Fax:
Practice Address - Street 1:150 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-6025
Practice Address - Country:US
Practice Address - Phone:603-213-0700
Practice Address - Fax:603-386-7007
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty