Provider Demographics
NPI:1902902604
Name:MORISSETTE, SANDRA B (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:B
Last Name:MORISSETTE
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 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:VABHS - PSYCHOLOGY SERVICE (116B)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-2471
Mailing Address - Fax:857-364-6539
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:VABHS PSYCHOLOGY SERVICE (116B)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-2471
Practice Address - Fax:857-364-6539
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8173103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical