Provider Demographics
NPI:1841268406
Name:SANDERS, CAROLYN R (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6208
Mailing Address - Country:US
Mailing Address - Phone:801-278-3027
Mailing Address - Fax:801-274-8296
Practice Address - Street 1:4774 HOLLADAY BLVD
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5444
Practice Address - Country:US
Practice Address - Phone:801-541-9078
Practice Address - Fax:801-274-8296
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14056235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5285452340002OtherCIGNA
UT37604633OtherUNITED BEHAVIORIAL HEALTH
UT621550311002Medicaid
UT37604633OtherUNITED BEHAVIORIAL HEALTH