Provider Demographics
NPI:1376091579
Name:SANDERSON, GARY TODD
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:TODD
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COUNTY HOSPITAL RD
Mailing Address - Street 2:#109
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9180
Mailing Address - Country:US
Mailing Address - Phone:530-283-6307
Mailing Address - Fax:
Practice Address - Street 1:270 COUNTY HOSPITAL RD
Practice Address - Street 2:#109
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971
Practice Address - Country:US
Practice Address - Phone:530-283-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1035031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical