Provider Demographics
NPI:1013060243
Name:STROTBECK, SALLIE P (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:SALLIE
Middle Name:P
Last Name:STROTBECK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BURNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6613
Mailing Address - Country:US
Mailing Address - Phone:609-927-1185
Mailing Address - Fax:609-569-1942
Practice Address - Street 1:3073 ENGLISH CREEK AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9711
Practice Address - Country:US
Practice Address - Phone:609-569-0239
Practice Address - Fax:609-569-1942
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00133100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ637057Medicare ID - Type Unspecified