Provider Demographics
NPI:1437428885
Name:SANDERS, ELLANA (MT- BC LCAT, CCBT)
Entity Type:Individual
Prefix:
First Name:ELLANA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MT- BC LCAT, CCBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 BELL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2168
Mailing Address - Country:US
Mailing Address - Phone:917-520-7476
Mailing Address - Fax:
Practice Address - Street 1:3850 BELL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2168
Practice Address - Country:US
Practice Address - Phone:917-520-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000817-1101YM0800X
NYBC225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000817-1OtherNYS OFFICE OF THE PROFFESSIONS