Provider Demographics
NPI:1417099953
Name:LAVIN-MOND, SANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LAVIN-MOND
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 1:1126 HI POINT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2610
Mailing Address - Country:US
Mailing Address - Phone:323-333-7390
Mailing Address - Fax:586-816-6929
Practice Address - Street 1:8665 WILSHIRE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2975
Practice Address - Country:US
Practice Address - Phone:323-333-7390
Practice Address - Fax:586-816-6929
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS104561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
212649604OtherUNITED BEHAVIORAL HEALTH
212649604OtherUNITED BEHAVIORAL HEALTH