Provider Demographics
NPI:1043504970
Name:STEMPLE, SANDRA (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:STEMPLE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11344 COLOMA RD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4457
Mailing Address - Country:US
Mailing Address - Phone:916-206-4193
Mailing Address - Fax:
Practice Address - Street 1:11344 COLOMA RD
Practice Address - Street 2:SUITE 605
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4457
Practice Address - Country:US
Practice Address - Phone:916-206-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257331041C0700X
CA27087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical