Provider Demographics
NPI:1861386914
Name:SANDBERG, IMAN SHAWKY (LAC)
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:SHAWKY
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:IMAN
Other - Middle Name:
Other - Last Name:METWALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 MADISON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1429
Mailing Address - Country:US
Mailing Address - Phone:201-328-6275
Mailing Address - Fax:
Practice Address - Street 1:131 MADISON AVE APT B
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1429
Practice Address - Country:US
Practice Address - Phone:201-328-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00325600103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling