Provider Demographics
NPI:1760039564
Name:SANDER, JORDAN BROWN (LCSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BROWN
Last Name:SANDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16-01 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2026
Mailing Address - Country:US
Mailing Address - Phone:201-797-0001
Mailing Address - Fax:201-796-0002
Practice Address - Street 1:16-01 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2026
Practice Address - Country:US
Practice Address - Phone:201-797-0001
Practice Address - Fax:201-796-0002
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL063630001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical