Provider Demographics
NPI:1649422312
Name:GERARDO, SANDRA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:M
Last Name:GERARDO
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 1:1600 IRON HORSE DR APT G301
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5721
Mailing Address - Country:US
Mailing Address - Phone:832-922-8831
Mailing Address - Fax:
Practice Address - Street 1:1600 IRON HORSE DR APT G301
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5721
Practice Address - Country:US
Practice Address - Phone:832-922-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37782104100000X
CO099269081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker