Healthcare Provider Details

I. General information

NPI: 1982512083
Provider Name (Legal Business Name): LORAINE SANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CLARKSON ST
BRIDGEPORT CT
06605-3240
US

IV. Provider business mailing address

100 CLARKSON ST
BRIDGEPORT CT
06605-3240
US

V. Phone/Fax

Practice location:
  • Phone: 203-543-4075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2412
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: