Healthcare Provider Details

I. General information

NPI: 1295395325
Provider Name (Legal Business Name): SANDRA SHAMMAS, LCSW, LCADC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SUSSEX ST
HARRISON NJ
07029-2123
US

IV. Provider business mailing address

211 SUSSEX ST
HARRISON NJ
07029-2123
US

V. Phone/Fax

Practice location:
  • Phone: 973-873-2951
  • Fax:
Mailing address:
  • Phone: 973-873-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA SHAMMAS
Title or Position: OWNER
Credential: LCSW, LCADC
Phone: 973-873-2951