Healthcare Provider Details

I. General information

NPI: 1992733521
Provider Name (Legal Business Name): SANDRA CATHERINE LOADER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 411 BOX 3448
APO AE BAYERN
09112
DE

IV. Provider business mailing address

CMR 411 BOX 3448
APO AE
09112
DE

V. Phone/Fax

Practice location:
  • Phone: 09662832100
  • Fax:
Mailing address:
  • Phone: 09662832100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW004553
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: