Provider Demographics
NPI:1407638935
Name:CHRISTIAN, SANDRA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:CHRISTIAN
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:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0081
Mailing Address - Country:US
Mailing Address - Phone:787-447-3949
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE ROBLE
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-7321
Practice Address - Country:US
Practice Address - Phone:787-447-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR68691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical