Provider Demographics
NPI:1265636039
Name:SANDLER, JANINE (LCSW 26657)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:SANDLER
Suffix:
Gender:F
Credentials:LCSW 26657
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2507
Mailing Address - Country:US
Mailing Address - Phone:510-508-0261
Mailing Address - Fax:
Practice Address - Street 1:2831 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3649
Practice Address - Country:US
Practice Address - Phone:510-508-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA601220137Medicaid