Provider Demographics
NPI:1356758536
Name:SANDRA S CHAMPA LCSW CAP LLC
Entity type:Organization
Organization Name:SANDRA S CHAMPA LCSW CAP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-784-2845
Mailing Address - Street 1:7437 PINE PARK DR S
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8852
Mailing Address - Country:US
Mailing Address - Phone:561-929-3792
Mailing Address - Fax:954-785-5808
Practice Address - Street 1:1825 FOREST HILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6058
Practice Address - Country:US
Practice Address - Phone:561-929-3792
Practice Address - Fax:954-785-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-19
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty