Provider Demographics
NPI:1376118604
Name:SANCHEZ, ADELIZ
Entity Type:Individual
Prefix:MS
First Name:ADELIZ
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ADELIZ
Other - Middle Name:
Other - Last Name:BURGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15843 89TH ST BSMT
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3103
Mailing Address - Country:US
Mailing Address - Phone:646-996-4842
Mailing Address - Fax:
Practice Address - Street 1:15843 89TH ST BSMT
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3103
Practice Address - Country:US
Practice Address - Phone:646-996-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1107503171103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool