Healthcare Provider Details

I. General information

NPI: 1053680686
Provider Name (Legal Business Name): TRISHA AS SANDERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BROAD TER
BLOOMFIELD NJ
07003-2726
US

IV. Provider business mailing address

20 BROAD TER
BLOOMFIELD NJ
07003-2726
US

V. Phone/Fax

Practice location:
  • Phone: 201-723-1776
  • Fax: 201-358-9141
Mailing address:
  • Phone: 201-723-1776
  • Fax: 201-358-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05368100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: