Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 44SL06233500 | NJ |
Y | 1041C0700X | Clinical Social Worker | 44SC05935700 | NJ |
NPI | 1003371352 |
---|---|
Provider Name | Fallon Sanchez |
First Address | Hazlet, NJ 07730-1532 |
Second Address | Hazlet, NJ 07730-1532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2019 |
Last Update Date | 27/09/2020 |