Provider Demographics
NPI:1073594602
Name:SANDERS, LISA M (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 STATE ROUTE 27
Mailing Address - Street 2:103
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1445
Mailing Address - Country:US
Mailing Address - Phone:908-507-6671
Mailing Address - Fax:732-951-2135
Practice Address - Street 1:3250 ROUTE 27
Practice Address - Street 2:103
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1536
Practice Address - Country:US
Practice Address - Phone:908-507-6671
Practice Address - Fax:732-951-2135
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053340001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY537624OtherVALUEOPTIONS
NYP3619540OtherOXFORD HEALTH PLANS
NYP3619540OtherOXFORD HEALTH PLANS