Provider Demographics
NPI:1649271545
Name:SACHS, YEDIDA PHYLLIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:YEDIDA
Middle Name:PHYLLIS
Last Name:SACHS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:SACHS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:28 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4089
Mailing Address - Country:US
Mailing Address - Phone:845-304-2368
Mailing Address - Fax:
Practice Address - Street 1:1029 TEANECK RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4514
Practice Address - Country:US
Practice Address - Phone:845-304-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047518001041C0700X
NYR032300-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11496161OtherCAQH