Provider Demographics
NPI:1740408434
Name:SAWYER, SANDRA H (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:H
Last Name:SAWYER
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 1:228 RUTH ANN WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-474-0105
Mailing Address - Fax:805-489-3434
Practice Address - Street 1:126 W BRANCH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:AARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-474-0105
Practice Address - Fax:805-489-3434
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS124771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11332348OtherCAQH UNIVERSAL CREDENTIAL
CA12477OtherLCSW