Provider Demographics
NPI:1366505216
Name:SANFORD, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 GARDINER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1045
Mailing Address - Country:US
Mailing Address - Phone:401-269-9940
Mailing Address - Fax:
Practice Address - Street 1:464 GARDINER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:RI
Practice Address - Zip Code:02892-1045
Practice Address - Country:US
Practice Address - Phone:401-269-9940
Practice Address - Fax:401-269-9940
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00319101YP2500X
RIMCH00319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional