Provider Demographics
NPI:1568676260
Name:GRIFMAN, SANDRA S (PHD MFC 12218)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:S
Last Name:GRIFMAN
Suffix:
Gender:F
Credentials:PHD MFC 12218
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CAMINO DE LOS MARES
Mailing Address - Street 2:#127
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-661-3071
Mailing Address - Fax:949-661-9041
Practice Address - Street 1:655 CAMINO DE LOS MARES
Practice Address - Street 2:#127
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-661-3071
Practice Address - Fax:949-661-9041
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist