Provider Demographics
NPI:1376683862
Name:RONFELD, SARA J (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:J
Last Name:RONFELD
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:58 PEPPERBUSH PL
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4472
Mailing Address - Country:US
Mailing Address - Phone:518-588-2349
Mailing Address - Fax:
Practice Address - Street 1:409 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5502
Practice Address - Country:US
Practice Address - Phone:518-588-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 048312-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0844Medicare ID - Type Unspecified