Provider Demographics
NPI:1497293245
Name:SANFORD, HEATHER (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SANFORD
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 1:201 EAST GREEN STREET
Mailing Address - Street 2:TOMPKINS COUNTY MENTAL HEALTH
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:13053
Mailing Address - Country:US
Mailing Address - Phone:607-274-6273
Mailing Address - Fax:
Practice Address - Street 1:201 EAST GREEN STREET
Practice Address - Street 2:TOMPKINS COUNTY MENTAL HEALTH
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:13053
Practice Address - Country:US
Practice Address - Phone:607-274-6273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090033104100000X
NY089431-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker