Provider Demographics
NPI:1346728821
Name:AUSTIN, SONDRA ANN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SCHENCK AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3613
Mailing Address - Country:US
Mailing Address - Phone:516-967-5221
Mailing Address - Fax:
Practice Address - Street 1:20 HICKSVILLE RD STE 5
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5819
Practice Address - Country:US
Practice Address - Phone:516-967-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045248-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical