Provider Demographics
NPI:1629549936
Name:MOORE, SARAH MCARDELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MCARDELL
Last Name:MOORE
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 1:2119 23RD TER # 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3425
Mailing Address - Country:US
Mailing Address - Phone:698-515-9069
Mailing Address - Fax:
Practice Address - Street 1:121 E 60TH ST APT 6E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1198
Practice Address - Country:US
Practice Address - Phone:212-879-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-13
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022530-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist