Provider Demographics
NPI:1720173768
Name:MACKINTOSH, SANDRA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:MACKINTOSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MAIN ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7407
Mailing Address - Country:US
Mailing Address - Phone:303-879-0010
Mailing Address - Fax:303-776-7680
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7407
Practice Address - Country:US
Practice Address - Phone:303-879-0010
Practice Address - Fax:303-776-7680
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical