Provider Demographics
NPI:1558676130
Name:MOORE, SANDRA CENTENO (LCSW)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:CENTENO
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1317 OAKDALE RD STE 440
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3364
Mailing Address - Country:US
Mailing Address - Phone:209-522-3362
Mailing Address - Fax:209-522-3363
Practice Address - Street 1:1317 OAKDALE RD STE 100
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3362
Practice Address - Country:US
Practice Address - Phone:209-522-3362
Practice Address - Fax:209-522-3363
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker