Provider Demographics
NPI:1437274461
Name:WARMERDAM, SANDRA YVONNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:YVONNE
Last Name:WARMERDAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:WARMERDAM
Other - Last Name:OBRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10426 EXCELSIOR AVE
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-584-2945
Mailing Address - Fax:559-584-9593
Practice Address - Street 1:310 N IRWIN ST
Practice Address - Street 2:STE 19
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-584-2945
Practice Address - Fax:559-584-9593
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS209151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ294152Medicare ID - Type Unspecified