Provider Demographics
NPI:1073733978
Name:SANDGRUND, ROBERT MAX (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MAX
Last Name:SANDGRUND
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 DELAWARE AVE
Mailing Address - Street 2:#210
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1140
Mailing Address - Country:US
Mailing Address - Phone:716-853-9555
Mailing Address - Fax:
Practice Address - Street 1:1310 DELAWARE AVE
Practice Address - Street 2:#210
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1140
Practice Address - Country:US
Practice Address - Phone:716-853-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075391-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical