Provider Demographics
NPI:1437246360
Name:BALDONI, SANDRA ELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ELLEN
Last Name:BALDONI
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 1:1175 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3639
Mailing Address - Country:US
Mailing Address - Phone:352-223-3394
Mailing Address - Fax:352-385-0128
Practice Address - Street 1:1175 LUCERNE DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-223-3394
Practice Address - Fax:352-385-0128
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002945000Medicaid
FL002945000Medicaid