Provider Demographics
NPI:1255176806
Name:ANDRES, SANDY
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:ANDRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 SEPULVEDA BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2522
Mailing Address - Country:US
Mailing Address - Phone:213-637-5000
Mailing Address - Fax:
Practice Address - Street 1:5805 SEPULVEDA BLVD STE 710
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2522
Practice Address - Country:US
Practice Address - Phone:213-637-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW964191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical