Provider Demographics
NPI:1942350715
Name:BLINN, SANDRA JONES (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JONES
Last Name:BLINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:BLINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW,LCSW
Mailing Address - Street 1:710 LAWRENCE EXPY
Mailing Address - Street 2:#340
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:408-851-3562
Mailing Address - Fax:408-851-3574
Practice Address - Street 1:710 LAWRENCE EXPY
Practice Address - Street 2:DEPT. 340
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-3562
Practice Address - Fax:408-851-3574
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALN121861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical