Provider Demographics
NPI:1396894739
Name:SARANDON, FRANCES (LIC PSYCH TECH)
Entity type:Individual
Prefix:MS
First Name:FRANCES
Middle Name:
Last Name:SARANDON
Suffix:
Gender:F
Credentials:LIC PSYCH TECH
Other - Prefix:MS
Other - First Name:FRANCES
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC PSYCH TECH
Mailing Address - Street 1:237 PICNIC AVE #28
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-455-8636
Mailing Address - Fax:
Practice Address - Street 1:250 BONAIR RD
Practice Address - Street 2:PES
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-499-6830
Practice Address - Fax:415-507-2672
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22691167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician