Provider Demographics
NPI:1811063365
Name:BENNETT, SANDRA THRASHER (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:THRASHER
Last Name:BENNETT
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 1:15021 OAK RANCH DR
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-9371
Mailing Address - Country:US
Mailing Address - Phone:559-798-1500
Mailing Address - Fax:559-741-1379
Practice Address - Street 1:204 N FLORAL ST STE C
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4957
Practice Address - Country:US
Practice Address - Phone:559-741-1378
Practice Address - Fax:559-741-1379
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 57491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical