Provider Demographics
NPI:1902224389
Name:SAND, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
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 1:623 EAGLE ROCK AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2948
Mailing Address - Country:US
Mailing Address - Phone:845-377-6463
Mailing Address - Fax:888-813-4274
Practice Address - Street 1:623 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2948
Practice Address - Country:US
Practice Address - Phone:845-377-6463
Practice Address - Fax:888-813-4274
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055799001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical