Healthcare Provider Details

I. General information

NPI: 1821849019
Provider Name (Legal Business Name): JOHN SANFORD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 W IVY ST
NEW HAVEN CT
06511-1739
US

IV. Provider business mailing address

286 W IVY ST
NEW HAVEN CT
06511-1739
US

V. Phone/Fax

Practice location:
  • Phone: 203-214-9932
  • Fax:
Mailing address:
  • Phone: 203-214-9932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16606
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: