Provider Demographics
NPI:1114165131
Name:SACKS, STEPHANIE ROBIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ROBIN
Last Name:SACKS
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 1:203 W 12TH ST
Mailing Address - Street 2:RM. 613
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7762
Mailing Address - Country:US
Mailing Address - Phone:212-604-8267
Mailing Address - Fax:212-604-8258
Practice Address - Street 1:203 W 12TH ST
Practice Address - Street 2:RM. 613
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7762
Practice Address - Country:US
Practice Address - Phone:212-604-8267
Practice Address - Fax:212-604-8258
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0438681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical