Provider Demographics
NPI:1093781221
Name:SERRANO, SANDRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PATTERSON CT
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-6810
Mailing Address - Country:US
Mailing Address - Phone:914-734-2220
Mailing Address - Fax:914-734-2220
Practice Address - Street 1:2127 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4329
Practice Address - Country:US
Practice Address - Phone:914-734-2220
Practice Address - Fax:914-734-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069744-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002266966Medicaid
NY002266966Medicaid
NYN3O781Medicare ID - Type Unspecified