Provider Demographics
NPI:1467005058
Name:MARIEN, SANDRA SOUSA (PMHNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SOUSA
Last Name:MARIEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MASSACHUSETTS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2959
Mailing Address - Country:US
Mailing Address - Phone:978-514-0747
Mailing Address - Fax:978-267-3597
Practice Address - Street 1:525 MASSACHUSETTS AVE STE 101
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2959
Practice Address - Country:US
Practice Address - Phone:978-514-0747
Practice Address - Fax:978-267-3597
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN231505163WP0808X, 363LP0808X, 364SP0807X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent