Healthcare Provider Details

I. General information

NPI: 1407339195
Provider Name (Legal Business Name): ELISA C SANDONATO-RUBBERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 ROUTE 47 S
RIO GRANDE NJ
08242-1608
US

IV. Provider business mailing address

1076 ROUTE 47 S
RIO GRANDE NJ
08242-1608
US

V. Phone/Fax

Practice location:
  • Phone: 609-741-6363
  • Fax: 609-435-5058
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05808600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: