Provider Demographics
NPI:1164598306
Name:SANDATE, LEDA MARCELA (MA)
Entity Type:Individual
Prefix:MRS
First Name:LEDA
Middle Name:MARCELA
Last Name:SANDATE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2040
Mailing Address - Country:US
Mailing Address - Phone:408-529-7222
Mailing Address - Fax:
Practice Address - Street 1:591 N KING RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1661
Practice Address - Country:US
Practice Address - Phone:408-793-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA50447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health