Provider Demographics
NPI:1083677330
Name:BARRIS, SARA LEA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:LEA
Last Name:BARRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:BARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:109-23 71 RD
Mailing Address - Street 2:1H
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-544-0932
Mailing Address - Fax:718-544-0932
Practice Address - Street 1:109-23 71 RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-544-0932
Practice Address - Fax:718-544-0932
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY91101103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical