Provider Demographics
NPI:1295035459
Name:SARDANOPOLI, DIANE C (LPC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:SARDANOPOLI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1921
Mailing Address - Country:US
Mailing Address - Phone:201-873-6496
Mailing Address - Fax:201-265-7641
Practice Address - Street 1:89 3RD AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2413
Practice Address - Country:US
Practice Address - Phone:201-873-6496
Practice Address - Fax:201-265-7641
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00343200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health