Provider Demographics
NPI:1982902201
Name:CANADA, LORI SANDLER (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:SANDLER
Last Name:CANADA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 THURBER DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1649
Mailing Address - Country:US
Mailing Address - Phone:315-539-1980
Mailing Address - Fax:315-539-1054
Practice Address - Street 1:31 THURBER DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1649
Practice Address - Country:US
Practice Address - Phone:315-539-1980
Practice Address - Fax:315-539-1054
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0813221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical