Provider Demographics
NPI:1043553829
Name:SANKARA, TAHARKA (LCSW, LCADC)
Entity type:Individual
Prefix:MR
First Name:TAHARKA
Middle Name:
Last Name:SANKARA
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SHREWSBURY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-7619
Mailing Address - Country:US
Mailing Address - Phone:732-337-8323
Mailing Address - Fax:
Practice Address - Street 1:713 BANGS AVE STE 3
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6905
Practice Address - Country:US
Practice Address - Phone:732-272-1340
Practice Address - Fax:732-272-1390
Is Sole Proprietor?:No
Enumeration Date:2013-03-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00174900101YA0400X
NJ44SC056442001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)