Provider Demographics
NPI:1982045191
Name:SANSONE, MICHAEL (LPC, NCSP, EDS, MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SANSONE
Suffix:
Gender:M
Credentials:LPC, NCSP, EDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 FAIRWAY TER
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2321
Mailing Address - Country:US
Mailing Address - Phone:856-787-7150
Mailing Address - Fax:856-787-1521
Practice Address - Street 1:108 FAIRWAY TER
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2321
Practice Address - Country:US
Practice Address - Phone:856-787-7150
Practice Address - Fax:856-787-1521
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00473500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional