Provider Demographics
NPI:1174548572
Name:SANDBERG, WILLIAM H (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5712
Mailing Address - Country:US
Mailing Address - Phone:207-773-7993
Mailing Address - Fax:207-773-5512
Practice Address - Street 1:205 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5712
Practice Address - Country:US
Practice Address - Phone:207-773-7993
Practice Address - Fax:207-773-5512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016056103TC0700X
103TP0814X
MEPS 1233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0005633OtherMEDICARE PTAN