=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437451051
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERLEY SAGET-MENAGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2010
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 ROUTE 168 SUITE 404A
-----------------------------------------------------
City | BLACKWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-6464
-----------------------------------------------------
Fax | 856-288-5139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 S BROADWAY STE 7
-----------------------------------------------------
City | PITMAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08071-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-365-7676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35SI00549100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------