Healthcare Provider Details

I. General information

NPI: 1407584238
Provider Name (Legal Business Name): ELIZABETH SAKS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 STATE ROUTE 15
LAFAYETTE NJ
07848-3208
US

IV. Provider business mailing address

12 MOUNTAINVIEW DR
ANDOVER NJ
07821-2119
US

V. Phone/Fax

Practice location:
  • Phone: 321-866-8884
  • Fax:
Mailing address:
  • Phone: 973-670-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: