Provider Demographics
NPI:1871574723
Name:SANDERSON, WILLIAM CHARLES (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1152
Mailing Address - Country:US
Mailing Address - Phone:908-759-3417
Mailing Address - Fax:732-805-9808
Practice Address - Street 1:46 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1152
Practice Address - Country:US
Practice Address - Phone:908-759-3417
Practice Address - Fax:732-805-9808
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC01287103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SA638883Medicare ID - Type Unspecified