Provider Demographics
NPI:1083932941
Name:MAK-LEE, SARA M (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:MAK-LEE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MAN-KUEN
Other - Middle Name:
Other - Last Name:MAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:197 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5507
Mailing Address - Country:US
Mailing Address - Phone:646-395-4260
Mailing Address - Fax:
Practice Address - Street 1:197 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5507
Practice Address - Country:US
Practice Address - Phone:646-395-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker