Provider Demographics
NPI:1255463097
Name:ALLEN, SANDRA JILL (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JILL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JILL
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:11301 WILSHIRE BLVD BLDG 206
Mailing Address - Street 2:ROOM 33
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4378
Practice Address - Street 1:11301 WILSHIRE BLVD BLDG 206
Practice Address - Street 2:ROOM 33
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4378
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16889104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker