Provider Demographics
NPI:1497885552
Name:HENRICHSEN, SANDRA P (LISW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:P
Last Name:HENRICHSEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14464 PECKHAM RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-9523
Mailing Address - Country:US
Mailing Address - Phone:440-834-4541
Mailing Address - Fax:
Practice Address - Street 1:7350 PALISADES PKWY
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5302
Practice Address - Country:US
Practice Address - Phone:440-918-1000
Practice Address - Fax:440-918-1029
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00100281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical