Provider Demographics
NPI:1104185024
Name:OKEN, SALLY B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:B
Last Name:OKEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:KESTENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9259 VISTA DEL LAGO
Mailing Address - Street 2:18C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3101
Mailing Address - Country:US
Mailing Address - Phone:561-235-5045
Mailing Address - Fax:
Practice Address - Street 1:9259 VISTA DEL LAGO
Practice Address - Street 2:18C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3101
Practice Address - Country:US
Practice Address - Phone:561-235-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-12
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30151041C0700X
CA261621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical