Healthcare Provider Details

I. General information

NPI: 1376792234
Provider Name (Legal Business Name): SANDRA LOUISE PLUMMER L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA LOUISE TILLEY

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PENDLETON DRIVE
HEBRON CT
06248-1525
US

IV. Provider business mailing address

25 PENDLETON DRIVE
HEBRON CT
06248-1525
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-9488
  • Fax: 860-228-1213
Mailing address:
  • Phone: 860-228-9488
  • Fax: 860-228-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000566
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: