Provider Demographics
NPI:1487840161
Name:SANFORD-TREISTMAN, XANDREA JEFFREY (MFTI, MA)
Entity Type:Individual
Prefix:MRS
First Name:XANDREA
Middle Name:JEFFREY
Last Name:SANFORD-TREISTMAN
Suffix:
Gender:F
Credentials:MFTI, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3005
Mailing Address - Country:US
Mailing Address - Phone:510-444-7771
Mailing Address - Fax:
Practice Address - Street 1:2407 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2465
Practice Address - Country:US
Practice Address - Phone:510-444-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist