Provider Demographics
NPI:1487276846
Name:LANIADO, SARA NATALIE (PSYD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NATALIE
Last Name:LANIADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ADMIN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3201
Mailing Address - Country:US
Mailing Address - Phone:508-279-5400
Mailing Address - Fax:
Practice Address - Street 1:20 ADMIN RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3201
Practice Address - Country:US
Practice Address - Phone:508-279-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10864103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic