MEDICARE: MRS. ELISA C SANDONATO-RUBBERT 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	44SC05808600	NJ

General Provider Information

NPI Number	:	1407339195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELISA C SANDONATO-RUBBERT LCSW

Provider Business Mailing Address
First Line	:	1076 ROUTE 47 S
Second Line	:
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1076 ROUTE 47 S
Second Line	:
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1608
Country	:	US
Telephone Number	:	609-741-6363
Fax Number	:	609-435-5058

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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