Provider Demographics
NPI:1104466846
Name:SAUDER, COLIN (PHD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:SAUDER
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 1:521 MOUNT AUBURN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4153
Mailing Address - Country:US
Mailing Address - Phone:617-744-8542
Mailing Address - Fax:
Practice Address - Street 1:521 MOUNT AUBURN ST STE 209
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4153
Practice Address - Country:US
Practice Address - Phone:617-744-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist