Provider Demographics
NPI:1881969988
Name:PAIT, SANDRA D
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:D
Last Name:PAIT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:DIANNE
Other - Last Name:WHITTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1499 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6050
Mailing Address - Country:US
Mailing Address - Phone:561-964-9040
Mailing Address - Fax:
Practice Address - Street 1:1499 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6050
Practice Address - Country:US
Practice Address - Phone:561-964-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health