Provider Demographics
NPI:1356760847
Name:CHAFIN, SANDRA RENE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RENE
Last Name:CHAFIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SANDY
Other - Middle Name:RENE
Other - Last Name:CHAFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:215 CALLE CORTEZ
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2240
Mailing Address - Country:US
Mailing Address - Phone:714-724-4480
Mailing Address - Fax:
Practice Address - Street 1:215 CALLE CORTEZ
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2240
Practice Address - Country:US
Practice Address - Phone:714-724-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical