Provider Demographics
NPI:1114637634
Name:STANFORD, SANDRA BARGERY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BARGERY
Last Name:STANFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:BARGERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3690 KITE ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-4011
Mailing Address - Country:US
Mailing Address - Phone:321-344-4216
Mailing Address - Fax:
Practice Address - Street 1:1067 CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6356
Practice Address - Country:US
Practice Address - Phone:407-314-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health