Provider Demographics
NPI:1588084164
Name:SERRA, SANDRA P (LCSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:P
Last Name:SERRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:P
Other - Last Name:SERRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1139 E. JERSEY ST.
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-340-7020
Mailing Address - Fax:
Practice Address - Street 1:1139 E. JERSEY ST.
Practice Address - Street 2:SUITE 610
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-340-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055603001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical