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General NPI Number Information
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NPI Number | 1841931011
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Entity Type | Individual
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Provider Name | SANDRA RACHEL JUSTIN LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/04/2022
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 1727 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10031-4611
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Country | US
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Telephone | 212-694-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 117 E 57TH ST APT 22B
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City | NEW YORK
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State | NY
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Zip | 10022-2095
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Country | US
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Telephone | 917-287-3205
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Fax | 212-421-2971
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 115934
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License Number State | NY
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