Provider Demographics
NPI:1265589931
Name:FLEISCHER-TODD, SARA M (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:FLEISCHER-TODD
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 1:2205 CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5273
Mailing Address - Country:US
Mailing Address - Phone:732-698-0380
Mailing Address - Fax:732-698-1349
Practice Address - Street 1:G9 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3338
Practice Address - Country:US
Practice Address - Phone:732-698-0380
Practice Address - Fax:732-698-1349
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ44SC002663001041C0700X
NYNYR029977-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ059712Medicare ID - Type Unspecified