Provider Demographics
NPI:1497817175
Name:DRESDNER, SANDRA ILYA (MSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ILYA
Last Name:DRESDNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:ILYA
Other - Last Name:SERBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:16 LEXINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2906
Mailing Address - Country:US
Mailing Address - Phone:973-635-5779
Mailing Address - Fax:973-635-5779
Practice Address - Street 1:16 LEXINGTON CT
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2906
Practice Address - Country:US
Practice Address - Phone:973-635-5779
Practice Address - Fax:973-635-5779
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000054001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJ LIC. # 44SC000054OtherLICENSE NUMBER