Provider Demographics
NPI:1376210922
Name:SANDERS, ANDREA (PSYD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 MILLBURN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3722
Mailing Address - Country:US
Mailing Address - Phone:973-313-9393
Mailing Address - Fax:973-313-1666
Practice Address - Street 1:2066 MILLBURN AVE STE 101
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3722
Practice Address - Country:US
Practice Address - Phone:973-313-9393
Practice Address - Fax:973-313-1666
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00532100103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist