Provider Demographics
NPI:1295470714
Name:MOORE, SARAH LUNDY (LCSW, MSED)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LUNDY
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W 71ST ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4174
Mailing Address - Country:US
Mailing Address - Phone:917-881-5475
Mailing Address - Fax:
Practice Address - Street 1:25 W 71ST ST APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4174
Practice Address - Country:US
Practice Address - Phone:917-881-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0660541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty