Provider Demographics
NPI:1164801403
Name:SANDERS, BRIDGETTE MITCHELL (LCSW, RPT-S)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MITCHELL
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8726 S SEPULVEDA BLVD # D-316
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4014
Mailing Address - Country:US
Mailing Address - Phone:310-752-9806
Mailing Address - Fax:
Practice Address - Street 1:8939 S SEPULVEDA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3658
Practice Address - Country:US
Practice Address - Phone:310-752-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS19549104100000X, 1041S0200X, 1041C0700X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst