Provider Demographics
NPI:1962169573
Name:SANFTNER, SEROM (LCSW)
Entity type:Individual
Prefix:
First Name:SEROM
Middle Name:
Last Name:SANFTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 WASHINGTON AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5943
Mailing Address - Country:US
Mailing Address - Phone:510-618-1580
Mailing Address - Fax:
Practice Address - Street 1:2450 WASHINGTON AVE STE 240
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5943
Practice Address - Country:US
Practice Address - Phone:510-618-1580
Practice Address - Fax:510-618-1570
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA986101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical