Provider Demographics
NPI:1568720092
Name:SANDERSON, LORI LYNN (LCSW, MPH, PHD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNN
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LCSW, MPH, PHD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MPH, PHD
Mailing Address - Street 1:33730 YUCAIPA BLVD # 1010
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2243
Mailing Address - Country:US
Mailing Address - Phone:909-260-8259
Mailing Address - Fax:
Practice Address - Street 1:33730 YUCAIPA BLVD # 1010
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2243
Practice Address - Country:US
Practice Address - Phone:909-260-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26313104100000X
CALCSW26313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26313OtherBOARD OF BEHAVIORAL SCIENCES