Provider Demographics
NPI:1245604206
Name:MEYER-PORCO, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MEYER-PORCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHURCH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1901
Mailing Address - Country:US
Mailing Address - Phone:914-421-4040
Mailing Address - Fax:
Practice Address - Street 1:20 CHURCH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1901
Practice Address - Country:US
Practice Address - Phone:914-421-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)