Provider Demographics
NPI:1053869115
Name:SACKS, MICHAEL LEE (LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:SACKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NORWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1829
Mailing Address - Country:US
Mailing Address - Phone:347-229-6228
Mailing Address - Fax:
Practice Address - Street 1:9 NORWOOD CT
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1829
Practice Address - Country:US
Practice Address - Phone:347-229-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00012900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional