Provider Demographics
NPI:1962043018
Name:SANDBERG, JOSEPH S (MSW, MBA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:S
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MSW, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5856
Mailing Address - Country:US
Mailing Address - Phone:405-651-8562
Mailing Address - Fax:
Practice Address - Street 1:512 SW 23RD ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5856
Practice Address - Country:US
Practice Address - Phone:405-227-8832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK203331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator