Healthcare Provider Details

I. General information

NPI: 1275554644
Provider Name (Legal Business Name): SANDRA J. MADRUGA M.S. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GEORGETOWN ROAD A CLEARLIGHT CENTER, INC.
BOXFORD MA
01921
US

IV. Provider business mailing address

8 WOODLAND AVE
SALEM NH
03079-2236
US

V. Phone/Fax

Practice location:
  • Phone: 978-887-2977
  • Fax: 978-359-2208
Mailing address:
  • Phone: 603-893-9984
  • Fax: 978-359-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1983
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: