Provider Demographics
NPI:1194241513
Name:SJOSTEDT, SAMUEL ANDREW
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ANDREW
Last Name:SJOSTEDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHARNOCK HILL CIR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1435
Mailing Address - Country:US
Mailing Address - Phone:774-364-1518
Mailing Address - Fax:
Practice Address - Street 1:18 SHAW ROAD
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436
Practice Address - Country:US
Practice Address - Phone:978-939-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health