Provider Demographics
NPI:1609907237
Name:SAGARA, KYOKO (LMHC, LP)
Entity Type:Individual
Prefix:
First Name:KYOKO
Middle Name:
Last Name:SAGARA
Suffix:
Gender:F
Credentials:LMHC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4201
Mailing Address - Country:US
Mailing Address - Phone:347-217-3316
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY STE 1113
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2007
Practice Address - Country:US
Practice Address - Phone:347-217-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003445-1101YM0800X
NY000620-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health