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General NPI Number Information
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NPI Number | 1497885552
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Entity Type | Individual
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Provider Name | SANDRA P HENRICHSEN LISW
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7350 PALISADES PKWY
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City | MENTOR
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State | OH
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Zip | 44060-5302
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Country | US
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Telephone | 440-918-1000
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Fax | 440-918-1029
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Provider Business Mailing Address
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Address Line | 14464 PECKHAM RD
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City | BURTON
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State | OH
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Zip | 44021-9523
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Country | US
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Telephone | 440-834-4541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I 0010028
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License Number State | OH
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