Provider Demographics
NPI:1164553152
Name:MULDOON, SANDRA LEE
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:MULDOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:MULDOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3420 GROMER TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1131
Mailing Address - Country:US
Mailing Address - Phone:818-370-7902
Mailing Address - Fax:
Practice Address - Street 1:3420 GROMER TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91214-1131
Practice Address - Country:US
Practice Address - Phone:818-370-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist