Provider Demographics
NPI:1518089598
Name:SHARP, SANDRA BUTLER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:BUTLER
Last Name:SHARP
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 1:567 PARK AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1754
Mailing Address - Country:US
Mailing Address - Phone:908-245-1432
Mailing Address - Fax:908-374-5490
Practice Address - Street 1:567 PARK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1754
Practice Address - Country:US
Practice Address - Phone:908-245-1432
Practice Address - Fax:908-245-0428
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002721001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSH638519Medicare ID - Type Unspecified