Provider Demographics
NPI:1770727141
Name:SANFORD, REBECCA LYNN (MSSA, LISW-S, LCSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MSSA, LISW-S, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WALTON AVE # A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1422
Mailing Address - Country:US
Mailing Address - Phone:216-410-3724
Mailing Address - Fax:
Practice Address - Street 1:214 WALTON AVE # A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1422
Practice Address - Country:US
Practice Address - Phone:216-410-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI07003041041C0700X
KY35951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical