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Organization
SONDERMIND PROVIDER NETWORK LLC
Active
Organization
SONDERMIND PROVIDER NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA ROACH (CREDENTIALING MANAGER)
(970) 329-7161
Entity
Organization
Contact information
Practice address
90 CANAL ST STE 4, BOSTON, MA 02114-2022
(844) 843-7279
Mailing address
PO BOX 738012, DALLAS, TX 75373-8012
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
02/19/2026
Last updated
02/19/2026
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