Provider Demographics
NPI:1881767119
Name:LANDA, SANFORD R (LCSW)
Entity type:Individual
Prefix:MR
First Name:SANFORD
Middle Name:R
Last Name:LANDA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CARLTON RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2430
Mailing Address - Country:US
Mailing Address - Phone:845-356-6372
Mailing Address - Fax:845-623-0648
Practice Address - Street 1:6 SMITH ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2913
Practice Address - Country:US
Practice Address - Phone:845-623-7782
Practice Address - Fax:845-623-0648
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7391101YA0400X
NYPRO22975 -11041C0700X
NJ44SC001896001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3I 01546134 2Medicaid
NYN8L691Medicare ID - Type Unspecified
NY3I 01546134 2Medicaid