Individual
JUDANA SANDRA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
45 DIMOCK ST, ROXBURY, MA 02119-1208
(617) 816-6505
Mailing address
PO BOX 191134, ROXBURY, MA 02119-0023
(617) 442-8800
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2278761
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/06/2020
Last updated
10/29/2025
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