MEDICARE: SONDER PSYCHOTHERAPY, PLLC

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1700476116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONDER PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	35 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-4004
Country	:	US
Telephone Number	:	603-513-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-4004
Country	:	US
Telephone Number	:	603-513-9445
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CYNTHIA TUBBS
Credential	:	LICSW
Telephone Number	:	603-513-9445

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	10/04/2021

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