Provider Demographics
NPI:1871770701
Name:LANDERS, SANDRA ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANNE
Last Name:LANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494081
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-4080
Mailing Address - Country:US
Mailing Address - Phone:954-668-7689
Mailing Address - Fax:888-821-8320
Practice Address - Street 1:2500 BOBCAT VILLAGE CENTER RD UNIT F
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-8476
Practice Address - Country:US
Practice Address - Phone:954-676-8860
Practice Address - Fax:888-821-8320
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 51531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ027POtherBLUE CROSS/BLUE SHIELD
FLZ027POtherBLUE CROSS/BLUE SHIELD