Provider Demographics
NPI:1285921346
Name:ROSENBLUM, SANDRA EVELYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:EVELYN
Last Name:ROSENBLUM
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 1:297 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1538
Mailing Address - Country:US
Mailing Address - Phone:201-803-1184
Mailing Address - Fax:
Practice Address - Street 1:297 KINDERKAMACK RD
Practice Address - Street 2:SUITE 212
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1538
Practice Address - Country:US
Practice Address - Phone:201-803-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004881001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical