Healthcare Provider Details

I. General information

NPI: 1275095572
Provider Name (Legal Business Name): REBECCA E SANDER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DOUGHTY DR STE 213
BREWER ME
04412-2289
US

IV. Provider business mailing address

1937 DEXTER RD
DOVER FOXCROFT ME
04426-4010
US

V. Phone/Fax

Practice location:
  • Phone: 802-365-1402
  • Fax:
Mailing address:
  • Phone: 802-579-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF6974
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: