Provider Demographics
NPI:1992790307
Name:SANDFORD, JOSEPH A (PH D)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:SANDFORD
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 TWINRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5270
Mailing Address - Country:US
Mailing Address - Phone:804-320-0158
Mailing Address - Fax:804-320-0242
Practice Address - Street 1:727 TWINRIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5270
Practice Address - Country:US
Practice Address - Phone:804-320-0158
Practice Address - Fax:804-320-0242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001756103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7755180Medicaid
VA271245OtherHEALTHKEEPERS
VA067425OtherANTHEM