Provider Demographics
NPI:1295842177
Name:FESTA, SANDY (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:FESTA
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 1:1401 ATLANTIC AVE
Mailing Address - Street 2:STE 2500-2600
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401
Mailing Address - Country:US
Mailing Address - Phone:609-572-8333
Mailing Address - Fax:
Practice Address - Street 1:2009 BACHARACH BLVD
Practice Address - Street 2:ATLANTICARE HEALTH SERVICES
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-3003
Practice Address - Country:US
Practice Address - Phone:609-344-5714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00571500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
781861Medicare ID - Type Unspecified
S1279Medicare UPIN