Provider Demographics
NPI:1295846442
Name:SANDOVAL, RENE Q (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:Q
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:8905 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6070
Mailing Address - Country:US
Mailing Address - Phone:916-753-5617
Mailing Address - Fax:916-922-7342
Practice Address - Street 1:811 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3466
Practice Address - Country:US
Practice Address - Phone:916-922-9868
Practice Address - Fax:916-922-7342
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA245991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical