Provider Demographics
NPI:1194357137
Name:SHAMMAS, SANDRA (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SHAMMAS
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2123
Mailing Address - Country:US
Mailing Address - Phone:973-873-2951
Mailing Address - Fax:
Practice Address - Street 1:211 SUSSEX ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2123
Practice Address - Country:US
Practice Address - Phone:973-873-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00288700106H00000X
NJ44SC058316001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist