Provider Demographics
NPI:1578816872
Name:SANFORD, LAURA B (LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PRO DR
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1360
Mailing Address - Country:US
Mailing Address - Phone:419-586-4030
Mailing Address - Fax:419-586-3268
Practice Address - Street 1:800 PRO DR
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1360
Practice Address - Country:US
Practice Address - Phone:419-586-4030
Practice Address - Fax:419-586-3268
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0800891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker