Provider Demographics
NPI:1336487511
Name:SANFORD, WILLIAM SIDNEY (CMSW, LMHP, LICSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SIDNEY
Last Name:SANFORD
Suffix:
Gender:M
Credentials:CMSW, LMHP, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4738 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2903
Mailing Address - Country:US
Mailing Address - Phone:402-215-5937
Mailing Address - Fax:888-616-1410
Practice Address - Street 1:4738 S 18TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2903
Practice Address - Country:US
Practice Address - Phone:402-215-5937
Practice Address - Fax:888-616-1410
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1041C0700X
NE44931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100255211-00Medicaid