Provider Demographics
NPI:1164628772
Name:SANFORD, JENNIFER (MS, MFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2512
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-8461
Mailing Address - Country:US
Mailing Address - Phone:860-874-4805
Mailing Address - Fax:
Practice Address - Street 1:1805 WHIMBREL CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5835
Practice Address - Country:US
Practice Address - Phone:916-249-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001295106H00000X
CA53158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist