Healthcare Provider Details

I. General information

NPI: 1093300527
Provider Name (Legal Business Name): SANDRA SERRANO LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 STAFFORD AVE
NEWARK DE
19711-5575
US

IV. Provider business mailing address

1803B PEACH ST
UPPER CHICHESTER PA
19061-2746
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-7779
  • Fax: 302-467-2920
Mailing address:
  • Phone: 267-688-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC0011064
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: