Provider Demographics
NPI:1043355258
Name:SANJOUR, CAROL BERNICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:BERNICE
Last Name:SANJOUR
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 1:944 PRESIDENT STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1653
Mailing Address - Country:US
Mailing Address - Phone:718-789-8696
Mailing Address - Fax:718-789-8696
Practice Address - Street 1:944 PRESIDENT STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1653
Practice Address - Country:US
Practice Address - Phone:718-789-8696
Practice Address - Fax:718-789-8696
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0113201103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist