Provider Demographics
NPI:1477632297
Name:BRONSON, SARRAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARRAH
Middle Name:
Last Name:BRONSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4D HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:WEST HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12491-5615
Mailing Address - Country:US
Mailing Address - Phone:914-391-7078
Mailing Address - Fax:
Practice Address - Street 1:275 FAIR ST STE 17B
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3882
Practice Address - Country:US
Practice Address - Phone:914-391-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8140103TC2200X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02009938Medicaid
NY81448OtherVALUE BEHAVIORAL HEALTH
NYP523165OtherOXFORD HEALTH PLANS
NY72992OtherGHI
NY02009938Medicaid