Provider Demographics
NPI:1780243378
Name:SANDERS, SCOTT (LMSW)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 STATE HIGHWAY 11C
Mailing Address - Street 2:
Mailing Address - City:NORTH LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:12967-1804
Mailing Address - Country:US
Mailing Address - Phone:505-470-2805
Mailing Address - Fax:
Practice Address - Street 1:17 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1093
Practice Address - Country:US
Practice Address - Phone:315-705-6564
Practice Address - Fax:315-705-6567
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker