Provider Demographics
NPI:1124200084
Name:KLONSKY, SANDRA M (MFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:KLONSKY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25411 CABOT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5520
Mailing Address - Country:US
Mailing Address - Phone:949-933-6157
Mailing Address - Fax:949-488-7057
Practice Address - Street 1:25411 CABOT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5520
Practice Address - Country:US
Practice Address - Phone:949-933-6157
Practice Address - Fax:949-488-7057
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 36576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist