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General NPI Number Information
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NPI Number | 1144383399
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Entity Type | Individual
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Provider Name | SANDRA VON DER FECHT L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 63 W MAIN ST STE I
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City | FREEHOLD
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State | NJ
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Zip | 07728-2141
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Country | US
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Telephone | 732-303-0515
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Fax | 732-863-9141
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Provider Business Mailing Address
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Address Line | 2 BELAIRE LN
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City | MANALAPAN
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State | NJ
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Zip | 07726-3349
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Country | US
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Telephone | 732-303-0515
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Fax | 732-863-9141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC006627
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License Number State | NJ
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