Doctor Name: | MR. JERRY SANDER |
NPI Number: | 1033243951 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.C.S.W.-R. |
License Number: | R0351191 |
Business Practice Address: | 92 South St Warwick, NY - 109901618 |
Business Phone Number: | 8459864462 |
Business Fax Number: | |
Mailing Address: | 92 South St, WARWICK |
State: | NY |
Postal Code: | 109901618 |
Phone Number: | 8459870094 |
Fax Number: | |
NPI Enumeration Date: | 03/15/2007 |
NPI Last Update Date: | 12/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | R0351191 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |