Provider Demographics
NPI:1124463245
Name:BANDETTINI, SANDRA BALL (MS, MFT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BALL
Last Name:BANDETTINI
Suffix:
Gender:F
Credentials:MS, MFT
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 2751
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-0751
Mailing Address - Country:US
Mailing Address - Phone:949-705-7938
Mailing Address - Fax:
Practice Address - Street 1:23276 S POINTE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1432
Practice Address - Country:US
Practice Address - Phone:949-705-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health