Provider Demographics
NPI:1528159324
Name:SANFORD, DAUREEN J (MA, MFT)
Entity type:Individual
Prefix:
First Name:DAUREEN
Middle Name:J
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W LEADORA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2017
Mailing Address - Country:US
Mailing Address - Phone:626-852-9552
Mailing Address - Fax:626-967-9670
Practice Address - Street 1:1175 E GARVEY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3677
Practice Address - Country:US
Practice Address - Phone:626-967-6421
Practice Address - Fax:626-967-9670
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist