Provider Demographics
NPI:1548360159
Name:DEAL, SANDRA NEWPORT (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:NEWPORT
Last Name:DEAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1494 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2504
Mailing Address - Country:US
Mailing Address - Phone:805-542-9681
Mailing Address - Fax:805-783-0211
Practice Address - Street 1:1494 MILL ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2504
Practice Address - Country:US
Practice Address - Phone:805-542-9681
Practice Address - Fax:805-783-0211
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical