Healthcare Provider Details

I. General information

NPI: 1518632462
Provider Name (Legal Business Name): SANDRA ANDERSON LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CONGRESS ST STE 225
SALEM MA
01970-5529
US

IV. Provider business mailing address

22 OLD CANAL DR
LOWELL MA
01851-2730
US

V. Phone/Fax

Practice location:
  • Phone: 508-521-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14842
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1140170
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: