Provider Demographics
NPI:1609352509
Name:AZAR, SANDRA T (PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:T
Last Name:AZAR
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 1:147 CLAIR LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8414
Mailing Address - Country:US
Mailing Address - Phone:814-863-6019
Mailing Address - Fax:
Practice Address - Street 1:PENNSYLVANIA STATE UNIVERSITY PSYCHOLOGY DEPT.
Practice Address - Street 2:MOORE BUILDING OFFICE 360
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-863-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4380103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist