Healthcare Provider Details

I. General information

NPI: 1801226154
Provider Name (Legal Business Name): SARAH LORETTA AMADOR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH LORETTA SOUTHWICK PH.D.

II. Dates (important events)

Enumeration Date: 11/23/2013
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MILLBURN AVE SUITE 1
SPRINGFIELD NJ
07081-1039
US

IV. Provider business mailing address

28 MILLBURN AVE SUITE 1
SPRINGFIELD NJ
07081-1039
US

V. Phone/Fax

Practice location:
  • Phone: 973-467-9333
  • Fax:
Mailing address:
  • Phone: 973-467-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00487800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: