Provider Demographics
NPI:1003015389
Name:CHAMSON, SANDRA P (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:P
Last Name:CHAMSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 86TH ST
Mailing Address - Street 2:18-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3303
Mailing Address - Country:US
Mailing Address - Phone:212-873-4242
Mailing Address - Fax:212-873-3676
Practice Address - Street 1:200 W 86TH ST
Practice Address - Street 2:18-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3303
Practice Address - Country:US
Practice Address - Phone:212-873-4242
Practice Address - Fax:212-873-3676
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical