Provider Demographics
NPI:1346850625
Name:SAPOFF, MALLORY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:SAPOFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MONROE ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6527
Mailing Address - Country:US
Mailing Address - Phone:516-244-9960
Mailing Address - Fax:
Practice Address - Street 1:68 LLOYD AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-4045
Practice Address - Country:US
Practice Address - Phone:516-244-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023779OtherNYS PSYCHOLOGIST LICENSE