Provider Demographics
NPI:1083898951
Name:MENDEZ EMMA, SARA M (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:MENDEZ EMMA
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 1:50 SHAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1505
Mailing Address - Country:US
Mailing Address - Phone:201-739-1946
Mailing Address - Fax:
Practice Address - Street 1:256 COLUMBIA TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1209
Practice Address - Country:US
Practice Address - Phone:973-765-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 0662021041C0700X
NJ44SC053754001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical