Provider Demographics
NPI:1851480271
Name:SITES CLARKE, SANDY K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:K
Last Name:SITES CLARKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:K
Other - Last Name:SITES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-941-0879
Mailing Address - Fax:207-941-0880
Practice Address - Street 1:77 COURT STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-941-0879
Practice Address - Fax:207-941-0880
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC33821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM4013Medicare ID - Type Unspecified