Provider Demographics
NPI:1750749461
Name:SITJAR-NERSESIAN, ALLYN RUTH (RDT, LCAT)
Entity type:Individual
Prefix:MS
First Name:ALLYN
Middle Name:RUTH
Last Name:SITJAR-NERSESIAN
Suffix:
Gender:F
Credentials:RDT, LCAT
Other - Prefix:MS
Other - First Name:ALLYN
Other - Middle Name:RUTH
Other - Last Name:SITJAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDT, LCAT
Mailing Address - Street 1:43 MAIN ST
Mailing Address - Street 2:OFFICE SUITE 101, ACTION ARTS CENTER
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1972
Mailing Address - Country:US
Mailing Address - Phone:201-415-5329
Mailing Address - Fax:
Practice Address - Street 1:43 MAIN ST
Practice Address - Street 2:OFFICE SUITE 101, ACTION ARTS CENTER
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1972
Practice Address - Country:US
Practice Address - Phone:201-415-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000657-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist