Provider Demographics
NPI:1609495894
Name:FLAMENCO DE PADILLA, SANDRA ELIZABETH (LCSW, ACHP-SW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:FLAMENCO DE PADILLA
Suffix:
Gender:F
Credentials:LCSW, ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8139 COACHLIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3510
Mailing Address - Country:US
Mailing Address - Phone:954-560-2737
Mailing Address - Fax:
Practice Address - Street 1:8139 COACHLIGHT CIR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3510
Practice Address - Country:US
Practice Address - Phone:954-560-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW161961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical