Provider Demographics
NPI:1912241571
Name:MARK SANDVOSS LLC
Entity Type:Organization
Organization Name:MARK SANDVOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:SANDVOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-362-3590
Mailing Address - Street 1:1505 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8921
Mailing Address - Country:US
Mailing Address - Phone:954-362-3590
Mailing Address - Fax:954-362-3589
Practice Address - Street 1:1505 N UNIVERSITY DR
Practice Address - Street 2:SUITE 403
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8921
Practice Address - Country:US
Practice Address - Phone:954-362-3590
Practice Address - Fax:954-362-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 77431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty