Healthcare Provider Details

I. General information

NPI: 1538933783
Provider Name (Legal Business Name): SANDRA DORNELUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 GEORGE ST
NEW BRUNSWICK NJ
08901-2020
US

IV. Provider business mailing address

615 N BROAD ST
ELIZABETH NJ
07208-3409
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: