Provider Demographics
NPI:1699044453
Name:LE, SANG T (BA)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1645
Mailing Address - Country:US
Mailing Address - Phone:856-767-5757
Mailing Address - Fax:
Practice Address - Street 1:280 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1645
Practice Address - Country:US
Practice Address - Phone:856-767-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health