Provider Demographics
NPI:1487712709
Name:SANJOUR, ROBERTA (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:SANJOUR
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 1:39 DANTE ST
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1608
Mailing Address - Country:US
Mailing Address - Phone:914-834-4669
Mailing Address - Fax:
Practice Address - Street 1:125 SPENCER PL
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-5601
Practice Address - Country:US
Practice Address - Phone:914-777-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013122511041C0700X
NY0004731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist