Provider Demographics
NPI:1699795294
Name:LAESER, SANDRA G (LMFT)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:G
Last Name:LAESER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MICHAEL FARADAY DR.
Mailing Address - Street 2:SUITE NUMBER 206
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5312
Mailing Address - Country:US
Mailing Address - Phone:703-608-6702
Mailing Address - Fax:
Practice Address - Street 1:1800 MICHAEL FARADAY DR.
Practice Address - Street 2:SUITE NUMBER 206
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5312
Practice Address - Country:US
Practice Address - Phone:703-608-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000996106H00000X
CAMFC35984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7413348Medicare UPIN
VA144537Medicare UPIN