Provider Demographics
NPI:1497806780
Name:RADER, SANDRA LD (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LD
Last Name:RADER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1745
Mailing Address - Country:US
Mailing Address - Phone:626-355-2272
Mailing Address - Fax:
Practice Address - Street 1:261 ADAMS ST
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1745
Practice Address - Country:US
Practice Address - Phone:626-355-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC 35332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist