Provider Demographics
NPI:1831381490
Name:HAYDEN, SANDRA MARY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARY
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:MARY
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 W BASTANCHURY RD 1A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2527
Mailing Address - Country:US
Mailing Address - Phone:714-773-4111
Mailing Address - Fax:714-773-4222
Practice Address - Street 1:111 W BASTANCHURY RD 1A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2527
Practice Address - Country:US
Practice Address - Phone:714-773-4111
Practice Address - Fax:714-773-4222
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS23303104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker