Provider Demographics
NPI:1811102437
Name:SANFORD, ELLEN MCDANIELS (MFT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MCDANIELS
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TAMAL PLZ
Mailing Address - Street 2:SUITE 195
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1125
Mailing Address - Country:US
Mailing Address - Phone:415-945-3200
Mailing Address - Fax:
Practice Address - Street 1:100 TAMAL PLZ
Practice Address - Street 2:SUITE 195
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1125
Practice Address - Country:US
Practice Address - Phone:415-945-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist