Provider Demographics
NPI:1477679918
Name:KELLOGG, SANDRA R (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:R
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WEST PL
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3614
Mailing Address - Country:US
Mailing Address - Phone:914-238-5497
Mailing Address - Fax:
Practice Address - Street 1:9 WEST PL
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3614
Practice Address - Country:US
Practice Address - Phone:914-238-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0194691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN27881Medicare PIN