Provider Demographics
NPI:1710248919
Name:SANDVOSS, MARK TAYLER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:TAYLER
Last Name:SANDVOSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W OAKLAND PARK BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1236
Mailing Address - Country:US
Mailing Address - Phone:954-931-9165
Mailing Address - Fax:
Practice Address - Street 1:2901 W OAKLAND PARK BLVD STE A1
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1236
Practice Address - Country:US
Practice Address - Phone:850-980-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 77431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical