MEDICARE: GRACE H SANDLIN 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	1041C0700X	Clinical Social Worker	77881	CA

General Provider Information

NPI Number	:	1295084549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE H SANDLIN LCSW

Provider Business Mailing Address
First Line	:	7410 MISSION VALLEY RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4405
Country	:	US
Telephone Number	:	858-552-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	9808 VENICE BLVD
Second Line	:	SUITE 700
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2732
Country	:	US
Telephone Number	:	310-945-3350
Fax Number	:	310-840-7023

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

Provider Enumeration Date	:	09/02/2012
Last Update Date	:	04/09/2026

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