Provider Demographics
NPI:1558542175
Name:NORRIS, SANDRA ELLEN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ELLEN
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ESTUDILLO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4639
Mailing Address - Country:US
Mailing Address - Phone:510-271-4917
Mailing Address - Fax:
Practice Address - Street 1:525 ESTUDILLO AVE. SUITE D
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577
Practice Address - Country:US
Practice Address - Phone:415-271-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist