Provider Demographics
NPI:1649204900
Name:SAND, ADELE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:ANNE
Last Name:SAND
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 1:4 CONSTELLATION PL APT 206
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-5495
Mailing Address - Country:US
Mailing Address - Phone:609-412-6086
Mailing Address - Fax:
Practice Address - Street 1:450 TILTON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1256
Practice Address - Country:US
Practice Address - Phone:609-412-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052987001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical