Provider Demographics
NPI:1275102220
Name:LIGHTSTONE, SANDRA NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:NICOLE
Last Name:LIGHTSTONE
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 1:253 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2705
Mailing Address - Country:US
Mailing Address - Phone:212-874-5461
Mailing Address - Fax:
Practice Address - Street 1:253 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2705
Practice Address - Country:US
Practice Address - Phone:212-874-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016758-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist