Provider Demographics
NPI:1083999700
Name:PIACENTE, SANDRA J (LMHC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:PIACENTE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 NW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-2839
Mailing Address - Country:US
Mailing Address - Phone:954-882-1066
Mailing Address - Fax:
Practice Address - Street 1:8358 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 202 A
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7319
Practice Address - Country:US
Practice Address - Phone:954-882-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health