Provider Demographics
NPI:1215429311
Name:DEACON CARR, SANDRA (PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DEACON CARR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 OLD EAST SCITUATE RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5719
Mailing Address - Country:US
Mailing Address - Phone:207-363-5785
Mailing Address - Fax:
Practice Address - Street 1:36 OLD EAST SCITUATE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-5719
Practice Address - Country:US
Practice Address - Phone:207-363-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7142-PY-PY103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling