Provider Demographics
NPI:1467920207
Name:FONTANA, SANDRA (LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:FONTANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-0576
Mailing Address - Country:US
Mailing Address - Phone:949-244-7171
Mailing Address - Fax:
Practice Address - Street 1:4425 JAMBOREE RD STE 264
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3002
Practice Address - Country:US
Practice Address - Phone:949-244-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT110213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist