Provider Demographics
NPI:1710662341
Name:SANDALWOOD MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:SANDALWOOD MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:508-538-3165
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-4081
Mailing Address - Country:US
Mailing Address - Phone:803-809-3184
Mailing Address - Fax:803-615-4662
Practice Address - Street 1:244 LATITUDE LN STE 104
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8125
Practice Address - Country:US
Practice Address - Phone:803-809-3184
Practice Address - Fax:803-615-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty