Provider Demographics
NPI:1063542686
Name:YEARLEY, SANDRA DUNBAR (MSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DUNBAR
Last Name:YEARLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ELM STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01982
Mailing Address - Country:US
Mailing Address - Phone:978-777-6672
Mailing Address - Fax:
Practice Address - Street 1:5 ELM STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01982
Practice Address - Country:US
Practice Address - Phone:978-777-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAFW1056351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP30100Medicare ID - Type Unspecified