Provider Demographics
NPI:1639497456
Name:BOURGEOIS, SHARON MICHELINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MICHELINE
Last Name:BOURGEOIS
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 1:430 WEST 34 ST
Mailing Address - Street 2:SUITE LE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-643-8278
Mailing Address - Fax:212-643-2417
Practice Address - Street 1:430 WEST 34 ST
Practice Address - Street 2:SUITE LE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-643-8278
Practice Address - Fax:212-643-2417
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health