Provider Demographics
NPI:1821540527
Name:LICHTMAN, SORYL SIMA (LMSW)
Entity Type:Individual
Prefix:
First Name:SORYL
Middle Name:SIMA
Last Name:LICHTMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RARITAN AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1719
Mailing Address - Country:US
Mailing Address - Phone:443-799-8833
Mailing Address - Fax:
Practice Address - Street 1:11 RARITAN AVE APT B3
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1719
Practice Address - Country:US
Practice Address - Phone:443-799-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06174000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker