Provider Demographics
NPI:1104179977
Name:GLASS, SARA (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CENTRAL PARK W APT 1U
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7214
Mailing Address - Country:US
Mailing Address - Phone:516-405-0362
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W APT 1U
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7214
Practice Address - Country:US
Practice Address - Phone:516-405-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08000531041C0700X
NY0800531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical