1629540257 NPI number — RHONDA JEAN SANFORD LCSW

Table of content: RHONDA JEAN SANFORD LCSW (NPI 1629540257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629540257 NPI number — RHONDA JEAN SANFORD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANFORD
Provider First Name:
RHONDA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATSON
Provider Other First Name:
RHONDA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629540257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COATESVILLE VAMC, ATTN: RHONDA SANFORD, LCSW,
Provider Second Line Business Mailing Address:
1400 BLACKHORSE HILL RD, BLDG 57, RM 227
Provider Business Mailing Address City Name:
COATESVILLLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-384-7711
Provider Business Mailing Address Fax Number:
610-383-0264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COATESVILLE VAMC, ATTN: RHONDA SANFORD, LCSW,
Provider Second Line Business Practice Location Address:
1400 BLACKHORSE HILL RD, BLDG 57, RM 227
Provider Business Practice Location Address City Name:
COATESVILLLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-384-7711
Provider Business Practice Location Address Fax Number:
610-383-0264
Provider Enumeration Date:
12/20/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW016686 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)