Healthcare Provider Details

I. General information

NPI: 1164592952
Provider Name (Legal Business Name): CHERYL MOTLEY SANDERS MSW UCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SUMMER STREET
STONEHAM MA
02180
US

IV. Provider business mailing address

108 SUMMER STREET PO BOX 80215
STONEHAM MA
02180
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-4166
  • Fax: 781-438-1493
Mailing address:
  • Phone: 781-438-4166
  • Fax: 781-438-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10188001
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: