Provider Demographics
NPI:1053959742
Name:PHILLIPS, SARA ASHLEY (LMSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:ASHLEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PASCACK RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7945
Mailing Address - Country:US
Mailing Address - Phone:201-788-9207
Mailing Address - Fax:
Practice Address - Street 1:440 WEST ST STE 312
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5028
Practice Address - Country:US
Practice Address - Phone:888-242-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06534100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker