Provider Demographics
NPI:1154671139
Name:GARRIS, SALLY ANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANNE
Last Name:GARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BOXER CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4219
Mailing Address - Country:US
Mailing Address - Phone:631-223-3488
Mailing Address - Fax:631-223-3488
Practice Address - Street 1:4 BOXER CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4219
Practice Address - Country:US
Practice Address - Phone:631-223-3488
Practice Address - Fax:631-223-3488
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024495104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker