MEDICARE: SANDRA J WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	001986	CT

General Provider Information

NPI Number	:	1306045422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA J WHITE

Provider Business Mailing Address
First Line	:	1230 RESERVOIR RD
Second Line	:
City	:	CHESHIRE
State	:	CT
Zip	:	06410-2923
Country	:	US
Telephone Number	:	203-626-9775
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 N MAIN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2537
Country	:	US
Telephone Number	:	203-379-7254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/28/2014

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Directions to “ SANDRA J WHITE ” Practice Location

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