Healthcare Provider Details

I. General information

NPI: 1538357645
Provider Name (Legal Business Name): SANDRA PATRICIA BARBERMOORE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17600 S SANTA FE AVE
COMPTON CA
90221-5401
US

IV. Provider business mailing address

550 S VERMONT AVE FL 11
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 310-761-2069
  • Fax: 310-764-0927
Mailing address:
  • Phone: 213-738-4398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: