Provider Demographics
NPI:1134510340
Name:SANDWEISS, BETH (MA, MSW, LPC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:SANDWEISS
Suffix:
Gender:F
Credentials:MA, MSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 N FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1709
Mailing Address - Country:US
Mailing Address - Phone:973-934-7358
Mailing Address - Fax:
Practice Address - Street 1:11 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-6304
Practice Address - Country:US
Practice Address - Phone:973-934-7358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00184100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional