Healthcare Provider Details

I. General information

NPI: 1457463978
Provider Name (Legal Business Name): SANDRA A CARLSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SANDRA A SALVESEN

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SUNSET RD
RINGWOOD NJ
07456
US

IV. Provider business mailing address

11 SUNSET RD
RINGWOOD NJ
07456
US

V. Phone/Fax

Practice location:
  • Phone: 973-962-4425
  • Fax: 973-383-9309
Mailing address:
  • Phone: 973-556-5434
  • Fax: 973-383-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC00168800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: