Provider Demographics
NPI:1700921863
Name:PISANO, SANDRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:PISANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2869
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-2869
Mailing Address - Country:US
Mailing Address - Phone:562-746-6121
Mailing Address - Fax:562-624-2819
Practice Address - Street 1:444 W OCEAN BLVD FL 8
Practice Address - Street 2:STE# 800
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4518
Practice Address - Country:US
Practice Address - Phone:562-746-6121
Practice Address - Fax:562-624-2819
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17765103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist