Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 001393 | CT |
N | 102L00000X | Psychologist | PS007751L | PA |
N | 103T00000X | Psychologist | PS007751L | PA |
NPI | 1003073149 |
---|---|
Provider Name | Dr. Sandra Kay Wiens |
First Address | Guilford, CT 06437-2349 |
Second Address | Guilford, CT 06437-1870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 24/11/2008 |