Provider Demographics
NPI:1790797744
Name:SANFT, RYAN RAMON SR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:RAMON
Last Name:SANFT
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22538 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5742
Mailing Address - Country:US
Mailing Address - Phone:909-824-0998
Mailing Address - Fax:
Practice Address - Street 1:1430 E COOLEY DR STE 111
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3944
Practice Address - Country:US
Practice Address - Phone:909-825-5128
Practice Address - Fax:909-825-8568
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 232581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical