Provider Demographics
NPI:1184831414
Name:SAGE, ROBERT E (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SAGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HENRY ST
Mailing Address - Street 2:APT. 18E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1752
Mailing Address - Country:US
Mailing Address - Phone:718-858-9507
Mailing Address - Fax:
Practice Address - Street 1:22 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1903
Practice Address - Country:US
Practice Address - Phone:718-260-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000678-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health