Provider Demographics
NPI:1629352265
Name:SABIN, BETHEL SARA (LAC)
Entity Type:Individual
Prefix:
First Name:BETHEL
Middle Name:SARA
Last Name:SABIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 41ST ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3607
Mailing Address - Country:US
Mailing Address - Phone:929-274-4140
Mailing Address - Fax:
Practice Address - Street 1:4720 41ST ST APT 1F
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3607
Practice Address - Country:US
Practice Address - Phone:929-274-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122697-01104100000X
FLAP3030171100000X
NY005196-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker