Provider Demographics
NPI:1265672661
Name:IWASAWA, SANDRA (LPC, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:IWASAWA
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POTTERY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-1522
Mailing Address - Country:US
Mailing Address - Phone:732-710-8228
Mailing Address - Fax:732-238-4185
Practice Address - Street 1:15 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2161
Practice Address - Country:US
Practice Address - Phone:732-254-8606
Practice Address - Fax:732-254-8606
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00344700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional