Provider Demographics
NPI:1396189734
Name:SEVERINO, SARAH L (PSYD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:SEVERINO
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 1:31 LEROY PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1711
Mailing Address - Country:US
Mailing Address - Phone:732-924-5104
Mailing Address - Fax:
Practice Address - Street 1:31 LEROY PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1711
Practice Address - Country:US
Practice Address - Phone:732-924-5104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019341103G00000X, 103T00000X
NJ35SI00502500103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist