Healthcare Provider Details

I. General information

NPI: 1003977216
Provider Name (Legal Business Name): MARIE T. SANDOLI PH.D., L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PHEASANT CT
AUBURN MA
01501-2457
US

IV. Provider business mailing address

PO BOX 665
EAST BROOKFIELD MA
01515-0665
US

V. Phone/Fax

Practice location:
  • Phone: 508-832-2953
  • Fax:
Mailing address:
  • Phone: 508-867-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1017526
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: