Provider Demographics
NPI:1487716270
Name:AMADOR MORA, SANDRA (MFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:AMADOR MORA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 POWELL ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2600
Mailing Address - Country:US
Mailing Address - Phone:510-496-3473
Mailing Address - Fax:
Practice Address - Street 1:1240 POWELL ST STE 2D
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2600
Practice Address - Country:US
Practice Address - Phone:510-496-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist