Provider Demographics
NPI:1164555926
Name:SANDS, CAROLE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANN
Last Name:SANDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 W END AVE
Mailing Address - Street 2:#8E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8401
Mailing Address - Country:US
Mailing Address - Phone:212-864-1016
Mailing Address - Fax:
Practice Address - Street 1:865 W END AVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8401
Practice Address - Country:US
Practice Address - Phone:212-864-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009439OtherNEW YORK STATE LICENSE
NYP2139461OtherOXFORD ID NUMBER
NYV8A811Medicare ID - Type Unspecified