Healthcare Provider Details

I. General information

NPI: 1548340508
Provider Name (Legal Business Name): GRETCHEN S SANDO LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BROAD ST
PLATTSBURGH NY
12901-3315
US

IV. Provider business mailing address

112 QUAKER HIGHLANDS RD
PERU NY
12972-5179
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-8000
  • Fax: 518-563-9001
Mailing address:
  • Phone: 518-643-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000805-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: