Healthcare Provider Details

I. General information

NPI: 1629406947
Provider Name (Legal Business Name): ALISSA K SANDLER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE CHILDREN'S HOSPITAL HACKENSACKUMC
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

30 PROSPECT AVE CHILDREN'S HOSPITAL HACKENSACKUMC
HACKENSACK NJ
07601-1914
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5131
  • Fax:
Mailing address:
  • Phone: 551-996-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00165600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: