MEDICARE: LENAEA MARIE SANDERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	82294	CA
2	1041C0700X	Clinical Social Worker	82294	CA

General Provider Information

NPI Number	:	1063762136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENAEA MARIE SANDERS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 552
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95759-0552
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9725 SORRENA WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-3212
Country	:	US
Telephone Number	:	916-667-9937
Fax Number	:	916-667-9937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	04/06/2019

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