Provider Demographics
NPI:1407379647
Name:SANCHEZ, KIERSTIN ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:ROSE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIERSTIN
Other - Middle Name:ROSE
Other - Last Name:GIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5740 RALSTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7847
Mailing Address - Country:US
Mailing Address - Phone:805-289-3100
Mailing Address - Fax:805-289-3395
Practice Address - Street 1:2240 E GONZALES RD STE 110
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8212
Practice Address - Country:US
Practice Address - Phone:805-961-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1035051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407379647OtherVCBH