Provider Demographics
NPI:1861112781
Name:SANJARI, BANAFSHEH
Entity type:Individual
Prefix:
First Name:BANAFSHEH
Middle Name:
Last Name:SANJARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 ANDERSON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4409
Mailing Address - Country:US
Mailing Address - Phone:484-682-8383
Mailing Address - Fax:
Practice Address - Street 1:1432 ANDERSON AVE FL 2
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4409
Practice Address - Country:US
Practice Address - Phone:484-682-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0937061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty