Provider Demographics
NPI:1134655863
Name:BRUHIM, SALLY (MA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:BRUHIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:MAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7366 192ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1858
Mailing Address - Country:US
Mailing Address - Phone:917-974-4782
Mailing Address - Fax:
Practice Address - Street 1:7366 192ND ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1858
Practice Address - Country:US
Practice Address - Phone:917-974-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool