Provider Demographics
NPI:1235368705
Name:BRACKENRIDGE, SANDRA STERN (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:STERN
Last Name:BRACKENRIDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 CREEK FALLS DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5186
Mailing Address - Country:US
Mailing Address - Phone:208-705-0088
Mailing Address - Fax:
Practice Address - Street 1:4206 CREEK FALLS DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5186
Practice Address - Country:US
Practice Address - Phone:208-705-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX523001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical