MEDICARE: MR. WILLIAM SANCHEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05369100	NJ

General Provider Information

NPI Number	:	1396231346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM SANCHEZ LCSW

Provider Business Mailing Address
First Line	:	1300 BROADWAY BLVD
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08757-2703
Country	:	US
Telephone Number	:	732-573-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	3512 QUENTIN RD STE 110
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	347-941-4933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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