Provider Demographics
NPI:1962719260
Name:SANDER, STEPHEN (LMSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SANDER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2911
Mailing Address - Country:US
Mailing Address - Phone:203-221-7869
Mailing Address - Fax:
Practice Address - Street 1:20 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:CT
Practice Address - Zip Code:06883-2911
Practice Address - Country:US
Practice Address - Phone:203-221-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081817-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker