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General NPI Number Information
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NPI Number | 1568720092
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Entity Type | Individual
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Provider Name | LORI LYNN SANDERSON LCSW, MPH, PHD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 33730 YUCAIPA BLVD # 1010
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City | YUCAIPA
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State | CA
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Zip | 92399-2243
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Country | US
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Telephone | 909-260-8259
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Fax |
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Provider Business Mailing Address
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Address Line | 33730 YUCAIPA BLVD # 1010
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City | YUCAIPA
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State | CA
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Zip | 92399-2243
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Country | US
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Telephone | 909-260-8259
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 26313
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW26313
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License Number State | CA
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