Provider Demographics
NPI:1174940845
Name:SCOTT, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CAS, MSW, LSW
Mailing Address - Street 1:306 WASHINGTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5162
Mailing Address - Country:US
Mailing Address - Phone:201-218-7431
Mailing Address - Fax:
Practice Address - Street 1:306 WASHINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5162
Practice Address - Country:US
Practice Address - Phone:201-218-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL058446001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical