Provider Demographics
NPI:1578651394
Name:SACKS, DAVID JON (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JON
Last Name:SACKS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2566
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2566
Mailing Address - Country:US
Mailing Address - Phone:410-495-8075
Mailing Address - Fax:410-495-8218
Practice Address - Street 1:135 W DARES BEACH RD
Practice Address - Street 2:SUITE 211
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3119
Practice Address - Country:US
Practice Address - Phone:410-495-8075
Practice Address - Fax:410-495-8218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical