Provider Demographics
NPI:1144846650
Name:STUART, SANDRA ALLISON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ALLISON
Last Name:STUART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 NESBIT TER
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1773
Mailing Address - Country:US
Mailing Address - Phone:862-668-9745
Mailing Address - Fax:
Practice Address - Street 1:264 NESBIT TER
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1773
Practice Address - Country:US
Practice Address - Phone:862-668-9745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058012001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical