Provider Demographics
NPI:1275037111
Name:SANDROCK, PHYLLIS (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:SANDROCK
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 1:37 CRAY TER
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1506
Mailing Address - Country:US
Mailing Address - Phone:908-377-6925
Mailing Address - Fax:
Practice Address - Street 1:37 CRAY TER
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1506
Practice Address - Country:US
Practice Address - Phone:908-377-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010264001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical