Provider Demographics
NPI:1467219907
Name:WIEDERMANN, SARAH DEENA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DEENA
Last Name:WIEDERMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:D
Other - Last Name:GREENES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 BURGUNDY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4670
Mailing Address - Country:US
Mailing Address - Phone:732-534-2047
Mailing Address - Fax:
Practice Address - Street 1:13 BURGUNDY WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4670
Practice Address - Country:US
Practice Address - Phone:732-534-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055184001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical