Provider Demographics
NPI:1144465717
Name:IZEN, SASHA G (PHD)
Entity type:Individual
Prefix:DR
First Name:SASHA
Middle Name:G
Last Name:IZEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PARK ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2960
Mailing Address - Country:US
Mailing Address - Phone:646-793-3768
Mailing Address - Fax:
Practice Address - Street 1:70 PARK ST STE 310
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2960
Practice Address - Country:US
Practice Address - Phone:646-793-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017922103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist