Provider Demographics
NPI:1093155426
Name:ANSANO, SAIRALYN REYES (LCAT)
Entity Type:Individual
Prefix:
First Name:SAIRALYN
Middle Name:REYES
Last Name:ANSANO
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:SAIRALYN
Other - Middle Name:ANSANO
Other - Last Name:THONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR-BC
Mailing Address - Street 1:204 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4711
Mailing Address - Country:US
Mailing Address - Phone:201-450-6292
Mailing Address - Fax:
Practice Address - Street 1:225 W 35TH ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:646-801-4724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY001658221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health