Healthcare Provider Details

I. General information

NPI: 1649271545
Provider Name (Legal Business Name): YEDIDA PHYLLIS SACHS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PHYLLIS SACHS L.C.S.W

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 TEANECK RD SUITE 2B
TEANECK NJ
07666-4514
US

IV. Provider business mailing address

28 FALCON WAY
WASHINGTON NJ
07882-4089
US

V. Phone/Fax

Practice location:
  • Phone: 845-304-2368
  • Fax:
Mailing address:
  • Phone: 845-304-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04751800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR032300-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier11496161
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerCAQH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: