Provider Demographics
NPI:1639686447
Name:PHILLIPS, SARAH (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PHILLIPS
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 1:4216 FAIRVIEW LN W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3610
Mailing Address - Country:US
Mailing Address - Phone:347-364-0228
Mailing Address - Fax:
Practice Address - Street 1:4216 FAIRVIEW LN W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3610
Practice Address - Country:US
Practice Address - Phone:347-364-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0863521041C0700X
NJ44SC058132001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherN/A