Healthcare Provider Details

I. General information

NPI: 1144281734
Provider Name (Legal Business Name): SANDRA ELIZABETH KENT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 STERLING ST SUITE 23
WEST BOYLSTON MA
01583-1200
US

IV. Provider business mailing address

45 STERLING ST SUITE 23
WEST BOYLSTON MA
01583-1200
US

V. Phone/Fax

Practice location:
  • Phone: 774-261-8530
  • Fax: 508-829-9158
Mailing address:
  • Phone: 774-261-8530
  • Fax: 508-829-9158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4763
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: