Provider Demographics
NPI:1932361284
Name:BOODMAN, SANDRA MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIE
Last Name:BOODMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E DYER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5600
Mailing Address - Country:US
Mailing Address - Phone:714-492-1012
Mailing Address - Fax:
Practice Address - Street 1:1221 E DYER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5600
Practice Address - Country:US
Practice Address - Phone:714-492-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker