Provider Demographics
NPI:1922151174
Name:WANDREI, KARIN EVON (LCSW)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:EVON
Last Name:WANDREI
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 1:7300 BORIS CT
Mailing Address - Street 2:#15
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928
Mailing Address - Country:US
Mailing Address - Phone:707-304-4245
Mailing Address - Fax:707-665-5682
Practice Address - Street 1:7300 BORIS CT
Practice Address - Street 2:#15
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:707-304-4245
Practice Address - Fax:707-665-5682
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALJ106091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical