Provider Demographics
NPI:1649205097
Name:NOOE, SANDRA DELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DELIA
Last Name:NOOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17684 AZUCAR WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1251
Mailing Address - Country:US
Mailing Address - Phone:858-335-1072
Mailing Address - Fax:858-674-4052
Practice Address - Street 1:16486 BERNARDO CENTER DR
Practice Address - Street 2:SUITE C-150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2518
Practice Address - Country:US
Practice Address - Phone:858-335-1072
Practice Address - Fax:858-674-4052
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS174521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW17452AMedicare ID - Type Unspecified