Provider Demographics
NPI:1538311733
Name:MLYNARCZYK, SARAH EAGLE KEENAN (ATR, LCAT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:EAGLE KEENAN
Last Name:MLYNARCZYK
Suffix:
Gender:F
Credentials:ATR, LCAT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:EAGLE
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR, LCAT
Mailing Address - Street 1:281 BENJAMIN RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-2403
Mailing Address - Country:US
Mailing Address - Phone:917-843-1375
Mailing Address - Fax:
Practice Address - Street 1:600 EAST 233RD STREET
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER, PSYCHIATRY, 7S
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:718-920-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001204221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist