Provider Demographics
NPI:1215480991
Name:ARREDONDO, SANJUANITA (LMSW)
Entity type:Individual
Prefix:
First Name:SANJUANITA
Middle Name:
Last Name:ARREDONDO
Suffix:
Gender:F
Credentials:LMSW
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 255
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-0255
Mailing Address - Country:US
Mailing Address - Phone:707-728-5131
Mailing Address - Fax:855-491-1095
Practice Address - Street 1:417 SECURITY SQ
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1922
Practice Address - Country:US
Practice Address - Phone:707-728-5131
Practice Address - Fax:855-491-1095
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC80631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018213Medicaid