Provider Demographics
NPI:1548303449
Name:DUCLOS, SANDRA E (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:E
Last Name:DUCLOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1179
Mailing Address - Country:US
Mailing Address - Phone:401-334-9104
Mailing Address - Fax:401-334-9105
Practice Address - Street 1:6 BLACKSTONE VALLEY PL
Practice Address - Street 2:SUITE 109
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1179
Practice Address - Country:US
Practice Address - Phone:401-334-9104
Practice Address - Fax:401-334-9105
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPS00498103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIR93575Medicare UPIN