Provider Demographics
NPI:1730641259
Name:SANDIFORD, PETA-GAYE T (LMHC)
Entity Type:Individual
Prefix:
First Name:PETA-GAYE
Middle Name:T
Last Name:SANDIFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MADISON SQ W FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1629
Mailing Address - Country:US
Mailing Address - Phone:347-947-7082
Mailing Address - Fax:914-462-3671
Practice Address - Street 1:16 MADISON SQ W FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1629
Practice Address - Country:US
Practice Address - Phone:347-947-7082
Practice Address - Fax:914-462-3671
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009392-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1700346400Medicaid