Provider Demographics
NPI:1144575770
Name:MANCHANDA, SANJAY (MA PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:MANCHANDA
Suffix:
Gender:M
Credentials:MA PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 E CALLE ALTIVO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5807
Mailing Address - Country:US
Mailing Address - Phone:520-577-7084
Mailing Address - Fax:520-325-7677
Practice Address - Street 1:4761 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1256
Practice Address - Country:US
Practice Address - Phone:520-403-4798
Practice Address - Fax:520-325-7677
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist