Provider Demographics
NPI:1730320300
Name:SANDERSON, CHERYL LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1654
Mailing Address - Country:US
Mailing Address - Phone:925-778-3800
Mailing Address - Fax:925-778-3915
Practice Address - Street 1:516 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1654
Practice Address - Country:US
Practice Address - Phone:925-778-3800
Practice Address - Fax:925-778-3915
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 232981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000007GWMedicaid