Provider Demographics
NPI:1104973874
Name:VAN SERTIMA, MARIA (LCSW, PHD)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:VAN SERTIMA
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 S ADELAIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1601
Mailing Address - Country:US
Mailing Address - Phone:732-828-5443
Mailing Address - Fax:732-828-5443
Practice Address - Street 1:59 S ADELAIDE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1601
Practice Address - Country:US
Practice Address - Phone:732-828-5443
Practice Address - Fax:732-828-5443
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002703001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105095000OtherMAGELLAN
NJ103890OtherMHN
NJ103890OtherMHN