Provider Demographics
NPI:1548721962
Name:STANFORD, SAYYID (LCSW)
Entity type:Individual
Prefix:MR
First Name:SAYYID
Middle Name:
Last Name:STANFORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 MDG, 280 DAVID L. GOLDFIEN STREET
Mailing Address - Street 2:BLDG 23
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49 MDG, 280 DAVID L. GOLDFEIN STREET
Practice Address - Street 2:BLDG 23
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:575-572-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11124104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker