Provider Demographics
NPI:1881712164
Name:CHASE, SANDRA BRYANT (MSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:BRYANT
Last Name:CHASE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:BRYANT
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1303 S RIMPAU BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3022
Mailing Address - Country:US
Mailing Address - Phone:213-807-1913
Mailing Address - Fax:213-807-1990
Practice Address - Street 1:711 S NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1831
Practice Address - Country:US
Practice Address - Phone:213-807-1913
Practice Address - Fax:213-807-1990
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16103OtherASW#