Provider Demographics
NPI:1023714532
Name:SANDATE, JENNY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:SANDATE
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 1:3900 S LOCKWOOD RIDGE RD APT 37
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-7647
Mailing Address - Country:US
Mailing Address - Phone:941-999-7485
Mailing Address - Fax:
Practice Address - Street 1:2201 CANTU CT STE 104
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6254
Practice Address - Country:US
Practice Address - Phone:941-999-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW209231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical