| Doctor Name: | DR. DOLLY R SACRISTAN |
| NPI Number: | 1013218528 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, LCSW |
| License Number: | 44SC05439600 |
| Business Practice Address: | 113 Adams Ave River Edge, NJ - 076612229 |
| Business Phone Number: | 2017764004 |
| Business Fax Number: | 2129600821 |
| Mailing Address: | 113 Adams Ave, RIVER EDGE |
| State: | NJ |
| Postal Code: | 076612229 |
| Phone Number: | 2017764004 |
| Fax Number: | 2129600821 |
| NPI Enumeration Date: | 11/15/2010 |
| NPI Last Update Date: | 11/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC05439600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |