Provider Demographics
NPI:1346865391
Name:ELSEHETRY, SARA (MA, MHC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ELSEHETRY
Suffix:
Gender:F
Credentials:MA, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8891 20TH AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7328
Mailing Address - Country:US
Mailing Address - Phone:718-249-7550
Mailing Address - Fax:
Practice Address - Street 1:111 DAHLGREN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3693
Practice Address - Country:US
Practice Address - Phone:718-745-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP103114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP103114OtherDEPARTMENT OF PROFESSIONAL LICENSING
NYP103114OtherDIVISION OF PROFESSIONAL LICENSING