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General NPI Number Information
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NPI Number | 1003073149
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Entity Type | Individual
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Provider Name | SANDRA KAY WIENS PHD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 26 LONG HILL RD
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City | GUILFORD
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State | CT
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Zip | 06437-1870
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Country | US
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Telephone | 203-453-1781
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Fax |
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Provider Business Mailing Address
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Address Line | 36 FERNWOOD DR
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City | GUILFORD
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State | CT
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Zip | 06437-2349
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Country | US
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Telephone | 203-376-9167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001393
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS007751L
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License Number State | PA
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